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I 



jiiUGHT Sleep 

! I! U AMERICA. 




9i3 in/ess Chi/ddiWA 

A. SMITH, M. D. 

33 2_ y ^ PPUCE 2S CENTS 

5fe4 ■ 

1915 




TWILIGHT 5LLEP 
IN AMERICA 



THE TRUTH ABOUT 
PAINLESS CHILDBIRTH 



By A. SMITH, M. D. 



( t« • * • » » 



» I 









c- «. 



THE VICTOR PUBLISHING CO. 

35 6ih AVENUE 
NEW YORK 



\ . 



Copyright, 1915, by 

THE VICTOR PUBUSHING CO. 

NEW YORK 







.•• 



• • • 



• • 



,• • 






• • 



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• • • 





. • • •• •• 



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I UUl- 

S4.4- 
I 915" 



POEEWOBD. 



i 



Twilight Sleep lias been known to the specialist in ob- 
stetrics for a number of years. Several years ago phy- 
sicians returning home from Germany brought accounts 
of painless childbirth. In the larger hospitals and clin- 
ics it was given a trial. Whether the technique was 
faulty or the drugs used not stable it is hard to say ; suf- 
fice to relate that Twilight Sleep was a dismal failure 
and, therefore, discontinued. 

In the Spring of 1914 those doctors who confine their 
work to obstetrics again experimented with this painless 
method of childbirth and were careful to follow, in every 
detail, the technique as carried out by the workers at 
the Frauenklinik at Freiburg. They gradually became 
aware that they were on the right track and that there 
was something in "Twilight" after all. 

In the early Summer of 1914 McClure'a Magazine be- 
gan a series of articles on the general subject of Twi- 
light Sleep. In Great Britain an English publication 
began a similar series. The women of America, Eng- 
land and of other countries, read of the wonderful re- 
sults obtained from the scopolamine-morphine method 
used in labor eases. The majority of physicians, for 
the first time, learned of the possibilities of painless 
childbirth. The more conservative called it a passing 
hysteria and behttled the method. 

The newspapers, knowing it was good news, gave much 
space to the subject. At first, accounts of women giving 
birth to live babies and without pain filled the columns. 

406fi7 _j 



FOBEWOBD. 

Later, various physicians, some of repute and honest 
in their convictions, and others unknown but seeking 
free advertisement, leaped into print and criticised, from 
every angle, this new-old method. Other magazines had 
articles on Twilight Sleep and "noted" doctors aired 
their views. At the time, it is safe to say that not as 
many as two hundred women in a)l the United States 
had been "Twilighted". Many extravagant claims were 
published. The laity conceived the idea that Twihght 
Sleep was a panacea for all pathological obstetrical con- 
ditions. 

Women flocked to the offices of their physicians seek- 
ing to learn the truth. No small number of the doctors 
were as uninformed upon the subject as were their pa- 
tients. Some were frank and truthfully admitted that 
they could not answer questions pertaining to this 
method. Others, just as ignorant but not as truthful, 
told their patients that it was dangerous both to mother 
and child, that it would not and could not last, that it was 
a "fake," and some even went so far as to impress upon 
their audience that it was against the dictates of God and 
nature. 

The press ceased to publish Twilight Sleep articles. 
The specialist continued to give it a fair and thorough 
trial. "Women were and are still asking, "What do you 
know about Twilight Sleep? Is it dangerous? What 
are the after effects? What about the baby? Could I 
have it in my case?" 

Thousands of women in America have been "Twi- 
lighted" up to the time tliis is written. Twilight Sleep 
is no fantastic dream. It is a reality. It is here to stay. 
Every new and many old methods in medicine and sur- 
; e opponents. Therefore, it is but natural that 



Twilight Sleep in Amebica. 5 

many men, the Tinknown country doctor and the city 
specialist, will continue to frown upon Twilight Sleep 
and give it no place in their work. 

Physicians from all parts of the globe, however, are 
flocking to the hospitals conducting Twilight Sleep cases, 
and under the instruction of the Visiting Obstetricians 
are learning the proper technique, indications and con- 
tra-indications of this method. In time Twilight Sleep 
will be a routine procedure with many doctors in certain 
types of cases. 

Hoping to correct errors of information, to give first 
hand the truth concerning Twilight Sleep, trusting that 
the facts presented for the reader's consideration will 
prove instructive, this small work has been written. 

The Authob. 



TWILIGHT SLEEP IN AMERICA. 

^ CHAPTER 1. 

^^ "Why Twilight Sleep? 

For centuries the average woman has suffered paiu 
during the process of bearing children. This statement 
applies to the average woman. There are isolated cases 
of childbirth in which the mother has endured little or 
no physical and mental suffering. This type of case is 
rare. The first baby, as a rule, is the worst from the 
standpoint of paia. Every physician, who has attended 
women during this critical period, can tell of no small 
number who have bad an easy labor and experienced a 
minimum of esbaustion following the happy advent of 
the offspring. In the majority of instances these are 
women who have had one or more children. In some rare 
eases the first baby occasions practically no anguish. 
Any doctor who has enjoyed a large obstetrical exper- 
ience knows of women who have had an easy time with 
the first, second, or third baby and have suffered the tor- 
tures of the damned during the birth process of the next 
child. Therefore it is impossible to foretell what a pros- 
pective mother will be forced to endure. 

The physician, however, in observing certain signs and 
taking cognizance of various fixed laws, in a measure, 
can play the prophet and, to a certain degree, foretell 
the type of the coming confinement. He observes the 
physical build of the woman. He measures her pelvic 
bones. He learns whether the birth canal is of a size to 
admit of the child's head. He, in a way, can tell whether 



Twilight Sleep in Ambbioa. 



the child's head is of the average size and whether there 
is any appreciable disproportion between that head and 
the diameters of the birth canal. The skilled obstetri- 
cian, in a majority of instances, can tell his patient 
whether she will deliver normally or have to undergo a 
CfEsarian operation. A Caesarian operation means that 
the woman is put under the influence of an anaesthetie 
and the abdomen and womb opened and the baby deliv- 
ered through this abdominal incision. So perfect is the 
technique of this operation that, in the absence of infec- 
tion or previous shock from various causes, only a small 
number of the mothers fail to recover and leave the bed 
at the end of from ten days to two weeks. 

The position of the child in the womb at the time of 
labor has much in making for an easy or a difficult de- 
livery. 

In a normal case the baby in the womb descends head 
foremost. The back of the child's head faces the moth- 
er's abdomen. Should the back of the child's head face 
the mother's back, or should a shoulder be presenting, 
or the child Ue transversely, or the feet present, etc., 
the position makes for complications and, in many in- 
stances, a difficult delivery. 

No small number of people, usually ultra-religious, be- 
lieve that the words of the ancient Hebrew, "In sorrow 
thou shalt bring forth children," are literally true and 
govern every confinement ease. These people either fail 
to think and apply their knowledge or else they are ig- 
norant. As we know, all women do not bring forth their 
children in sorrow, even in this age of civilization. As 
the God of one is the God of all and agreeing that He is 
a just God, the fair minded will not admit of this state- 
ment because what would apply to one should apply to 




J 



Why Twilight Sleep? 

all. If there are cases among civilized peoples where the 
women do not suffer while bearing their children it ia 
also true that the further away from civilization we 
travel the more simple and painless is the process of 
birth. 

To the student the thought that the savage woman pre- 
sents the normal obstetrical condition impresses itself. 

We know that among primitive tribes, the American 
Indians, and uncivilized people, the woman in labor suf- 
fers practically no pain. Furthermore the more unciv- 
ilized and primitive the woman the shorter is the time of 
labor. This is the ideal state. A woman in labor two 
to three hours, enduring no physical suffering, a few 
hours post-partum giving no evidence of having given 
birth to an offspring, normal in vitality and storing up 
no disagreeable memories in her brain cells, this is what 
all labor should be, but alas, such a case is rarely known 
to the city doctor. 

We know from good sources that an Indian woman 
hunting with her tribe has suddenly realized that she 
was about to give birth to a child. Allowing the mem- 
bers of the tribe to proceed the pregnant woman has 
abandoned her horse, usually near a stream. Spreading 
an old Buffalo robe on the ground, or making a blanket 
of dried bushes and leaves, she has had her baby. Cleans- 
ing herself in the running water, she has bundled up the 
new baby, mounted her horse and overtaken the other 
members of her tribe. As a rule, though, the Indian 
mother was accompanied by another woman and kept 
apart from her people until the delivery was over. Prom 
what we can learn these people rarely suffered pain, and 
an abnormal case was exceptional. Of course there must 
have been abnormal eases, and women died during child- 



10 



TwiuoHT Sleep in America. 



birth, and many babies were born dead, but taking the 
Indian and averaging the taaes we have record of, theirs 
Was an easy state during the dehvery as compared to the 
average woman of to-day. 

Englemann's book, "Labor Among Primitive People", 
for pages, dwells with authentic reports of labor cases 
with an absence of pain. 

We have learned that when we approach civilization 
the suffering coincident to and the length of time for a 
labor case is multiplied in proportion to the distance 
from the primitive and to the nearness of civihzation. 
Therefore, for esample, the half eivihzed Mexican wo- 
man is usually in labor from four to six hours and suf- 
fers a mild degree of pain. 

And so we come to the people about us. We live bene- 
fiting from the by-products of civilization. The woman 
of to-day, enjoying this civilization, as a rule, looks for- 
ward with dread to pregnancy and the delivery of her 
offspring. And well she may, for more than one physi- 
cian has said that were it possible for him to bear a 
child, from his knowledge of the suffering it entails, race 
suicide would be vogue. 

Let us dwell awhile and learn, if we may, the causes 
for this universal suffering of maternity. 

Among the primitive peoples intermarriage with mem- 
bers of other tribes was not the rule. If one member of 
a tribe did intermarry, in many instances, they made 
sure that the stature of the individuals was similar. Onr 
tribe averaging five feet in heighth would not intermari 
with a tribe averaging six feet in heighth. They learnc 
that if a woman standing four feet, married a man of 
tribe who, as a rule, was five feet ten inches in statur 
the child would be out of proportion to the measureme' 



Why Twilight Sleep f 

of the mother 'n birth canal and dead mothers and babiea 
might result. 

This rule is not observed among the people of civili- 
zation. Intermarriage is common between people of 
different nationalities. In America it is the rule rather 
tha,u the exception. For this reason, although both the 
man and woman be of average statue, a woman with nor- 
mal measurements will have a child in-utero of such a 
size that a normal birth is impossible, or if possible, very 
difSeult. This disproportion, to a certain extent, makes 
for difficult labors and pain. 

Among civilized peoples the more idle the life of the 
woman the more painful and difficult, as a rule, is the 
labor. 

Among the German peasants, the hard working Danes, 
the muscular Swedes, the minimum of pain endured as 
compared to the American girl of fashion cannot but be 
contrasted by those who have bad experience with both 
tjTies. You naturally ask, "Why is this the case?" 

The womb is a muscular organ. The abdominal mus- 
cles have a function to perform in all labor. Before a 
child can be born the cervix (neck of the womb) must 
dilate to a sufficient size to permit of the passage of the 
child's head. The muscular contractions of the womb, 
aided by the abdominal muscles, cause the child's head 
(in a normal case) to dilate the cervix and force the child 
into the world. 

Among the uncivilized peoples and certain civilized 
nations of to-day, the females perform a certain amount 
of manual labor. They work. Fix this idea fast in your 
mind. They work and as a result the womb is devel- 
oped as are the abdominal organs. Following this train 
of thought, it is but natural that when such a type of 



^^ bee 

^^L mm 
^^K doe 



12 Twilight Sleep in Amebica. 

woman goes into labor, her muscular mechanism and her ^ 
nerve reserve are in a perfect state. The cervix dilates 
causing a minimum of pain. The muscular contractions 
are regular and have force. The result is a fairly quick 
delivery with practically no nerve fatigue following. The 
womb is quick to contract to its normal size. This is pos- 
sible because it is a developed organ both from a muscu- 
lar and a nerve standpoint. The nervous system being 
in such excellent condition the mother produces rich milk 
in goodly quantity. She is able to nourish her child and 
with food to spare. She can arise early and go on with 
her duties. 

Is it necessary to give a resume of the life led by the 
average American girl of to-dayi The country girl leads 
a better existence (from a medical viewpoint) than does 
her city sister. Let us pause and see what kind of life 
is led by the average girl of a large city. 

She begins her schooling at six years of age. Before 
she is ten years old she goes to "parties", remains awake 
long past her bed hour and draws on her nerve reserve. 
She is beginning her career of burning the candle at both 
ends. By the time she is fourteen years old she finds 
"parties" a bore and begins to ape her older sisters. 
She is hardly launched on the road of womanhood when 
she studies the styles in corsets. At eighteen she will 
tell yon that she would get a back-ache if she left them 
off a minute. Her exercise may be a sporatic try at 
tennis during the warm months or an attempt at golf. 
Ten city blocks is a long walk. (There are exceptions — 
this we admit). For years the French heeled shoe has 
been fashionable. She is a slave to the latest mode and 
must wear them. Only when she plays tennis or golf 
does she take to flat-heeled, common sense shoes and, in 



J 



"Why Twilight Sleep! 13 

many cases, she complains of aching feet in a surpris- 
ingly short time. Every few years we are met with a 
new walk or manner of bending the body. We have 
laughed at the Greeciau bend. We have suffered the 
debutante slouch. Late to bed . . late to rise . . has 
been the slogan. She suffers from chronic constipation. 
At twenty she has "nerves". She has never learned to 
breathe properly. She dabbles at her food and lives on 
impossible dishes. She is a victim of auto-intoxication. 
Her one aim in life is to make herself attractive, and for 
real strenuous exercise she crochets ends for towels or 
works monograms. Her waist line is constricted. Her 
hips for years have been tightly encased in corsets pre- 
venting a proper blood supply. In all fairness, we must 
admit that the style of corset of to-day is bordering on 
the sensible and is modelled with an idea of physiological 
principles. But corsets are still an abuse. Should we di- 
rect our attention to the child of fashion as we find her 
in all large cities, we discover other and worse vices. 
Before she is twenty years old she knows several brands 
of cock-tail, has her preferences for what makes of 
whiskey will constitute a pleasant high-ball and orders 
the wine that happens to be the rage. We are not con- 
cerned whether this is her privilege or not, ethically 
it may be, but from the standpoint of bearing children it 
adds to the pathological. 

Add slightly to or detract from this description and let 
us see this gir! married. Her nervous organism is far 
from normal. Her abdominal muscles are flabby. It 
may be said that she has no abdominal muscles. She is 
neurotic. And then she becomes pregnant. When the 
time for her baby arrives she is poorly equipped for the 
experience. She goes into labor. We assume her meas- 



14 



Twilight Sleep in Asibbica, 



urements, the child's measarements and position to be 
normal. Before she is fairly launched on her labor she 
becomes fretful and cries out that she knows she won't 
be able to stand the pain. The uterine contractions in- 
crease in power and occur at shorter intervals of time. 
She yells with the pain and begs the doctor to "do some- 
thing". Just when she requires her nerve reser\'e it is 
exhausted. Just when her muscles have a function to 
perform they tire. What then? She can't go on with 
her labor. She suifers agonizing pain but there are no 
expulsive contractions. The physician either gives a nar- 
cotic which induces sleep and thus permits her to re- 
cover her muscular and nerve power, or else he employs 
a general anesthetic and delivers the baby with forceps. 

What of the mother after the baby arrives? In this 
ease she is usually a pitiful sight. To look at her a few 
hours later or the next day one readily gathers that she 
has been through a severe ordeal. She is tired. She 
will tell you that she is completely "done up." She is 
exhaustion plus. She looks pale, wan. She either pro- 
duces no milk or else the milk is of poor quality. Ten 
days or three weeks later she tries sitting in a chair. 
Many days later she attempts to go out of doors. Weeks 
have passed before she is anywhere near her old self 
again . . and lier old self, at best, presents a poor speci- 
men of womanhood. 

What of the next baby? Aak any woman of this type, 
and they are not rare, when she expects to have another 
baby. The answer comes quickly. She will not have 
another child. Six months later she says the same thing. 
Two years later you get the same answer. She remem- 
bers her labor as one remembers a nightmare. The 
thought of another child makes a chilly sensation shoot 



J 



Why Twilight Sleep? 15 

liirough her spine. A terrible dread fills her being when 
she thinks of herself going through another confinement. 
Nothing will induce her again to become pregnant. She 
resorts to any means to keep from conceiving. She pre- 
sents the picture of the one child sterility, from choice. 

From what has gone before the reader must not form 
the opinion that this is true in all cases. There are 
women who, although they suffer and have hard labors, 
are not made invalids and cheerfully bear other children. 
There are women who dread pregnancy but still become 
pregnant several times. Some do this as a matter of 
duty, or it resolves itself into a religious or personal is- 
sue. Some women lead simple, hygienic lives, conceive, 
expect an "easy time" and suffer untold agony. 

Therefore it being an established fact that no small 
number of women endure exquisite pain during the pro- 
cess of childbirth, are nervous wrecks for weeks follow- 
ing the birth of the baby, and practice future sterility 
because they fear and dread the anguish of another con- 
finement . . science has at last solved their problem. 

For the woman who bears children easily; for the wo- 
man who has no apprehension of the future delivery ; for 
the woman who has had several children and does not 
think labor any extraordinary ordeal, Twilight Sleep is 
of little interest to them. 

These pages treating of the general subject of Twilight 
Sleep are intended for the woman who fears the ordeal 
E childbirth. 




Twilight Sleep in America. 



OHAPTEE 2. 



The Evolution of Twilight Slebp. 



I 



In order to get a clear and logical understanding of 
Twilght Sleep a consideration of the discovery of anses- 
thesia and what it has done for the human race is nec- 
essary. The beginning of anEesthesia goes back to re- 
mote antiquity. It is symbolized in the 21st verse of the 
2nd Chapter of Genesis; "And the Lord God caused a 
deep sleep to fall upon Adam, and he slept : and he took 
one of his ribs, and closed up the flesh instead thereof,*' 

Passing periods of time we read of the soothing Egyp- 
tian nepenthe of the Odyssey which Helen east into the 
wine for Ulysses to partake of. The Talmud speaks of 
the "samme de shinta". In the Arabian Nights we read 
of the "bhang". Shakespeare tells us of the "drowsy 
syrups". The Orientals well knew the soporific proper- 
ties of opium, Indian Hemp (Cannabis indica), the man- 
drake, henbene (Hyoscyamus), dewtry, hemlock and let- 
tuce. The Greeks also knew of these drugs, and their 
effects when taken. Hugh of Lucca and his son Theo- 
dorie, famous surgeons of medieval times, used a mix- 
ture of some of the above mentioned drugs ("oleum de 
lateribus") as a surgical anesthesia. 

The use of such natural antiseptics as extreme dry- 
ness, smoke (creosote), honey, nitre, and wine was long 
known to early man. The use of such narcotics and 



ong j 



The EvoLUTiosr of Twilight Sleep. 

toxicants as alcohol, opium, hashish, or mescal, was 
known first by primitive man, to whom also such luxuries 
as tea, coffee, cocoa, and tobacco were enjoyed. 

Before the discovery and the application of anaesthet- 
ics, as the term is used to-day, it was the custom when 
ye olde time surgeon wished to operate upon some un- 
fortunate human to feed the victim plenty of narcotics, 
deleriants and intoxicants. When the patient was con- 
sidered in the proper state he was tied to the so-called 
operating table. The operator had many assistants . . 
often as many as from four to eight. They did not as- 
sist at the operation itself. As is customary to-day one 
or two assistants were needed in the actual work of op- 
erating. But after the patient had been ' ' doped, drugged 
and rendered well intoxicated" and had been tied se- 
curely to the operating table, the extra assistants further 
served to hold the patient. In those days, it will be 
readily seen, surgery must have been crude. A skillful 
surgeon was known by the speed with which he worked. 
A surgeon who could remove a leg in four minutes was 
a far better surgeon than one who took ten minutes. 
The end results did not count. Technique and "good 
surgery" were of third importance. Speed came first; 
the feelings of the patient came second ; and the refine- 
ments making for good work a poor third. In obstet- 
rics, there being no anaesthetic to give, the women en- 
dured terrible suffering. 

The history of the early work of amesthesia in America 
has been the subject of bitter debate for many years. 
Here is no place to argue the matter pro and con but a 
brief consideration of the facts will suffice. Doctor 
Crawford Williamson Long (1815-1878), a graduate of 
the University of Pennsylvania (1839), practiced medi- 



18 



TwnJGHT Bleep in j 



cine at Danielsville, Ga. Dr. Long had previously noted 
that ether had aniesthetic properties. These observa- 
tions were purely accidental. So he gave a patient ether 
and removed a small cystic growth from the back of the 
neck. The experiment was successful. Later (1842- 
1843) he used ether in the other cases which have been 
certified and vouched for by resident physicians of his 
locality. Doctor Long made no scientific records of his 
uses of etlier nor did he publish any essay upon the sub- 
ject. Therefore the profession has had to waive first 
place in his case. 

Sir Humphrey Davy of Penzance, England, in 1800 
carried on a series of experiments using himself as the 
subject. He experimented with nitrous oxide, which is a 
gas. As a result of his work be said that "it may prob- 
ably be used with advantage in Surgical operations in 
which no great effusion of Blood takes place," 
• Xn 1844, Horace Wells (1915-1848), practiced dentistry 
in Hartford, Connecticut. He began to use nitrous oxide 
in dental work. He confided in his friend and partner 
tiie results of his work. This friend and partner was 
William Thomas Greene Morton (1819-1868), of Charl- 
ton, Massachusetts. Even to-day an ansesthetic is not 
without a certain element of risk to the patient and so 
it was no wonder, in those early days of anesthesia, a 
fatal case should have fallen to the lot of one of the work- 
ers. It was Wells' misfortune to have had a case die 
from the effects of the ansesthetic. He retired from 
practice and eventually put an end to his life. 

William Morton, in the meantime, had begun the study 
of medicine. In those days every medical student bad a 
preceptor, a physician who was recognized and who acted 
as sponsor and teacher to the embryonic doctor. Mor- 



J 



^Po 



Ill's preceptor was Doctor Charles T. Jackson, a chem- 
ist of ability. He pointed out to Morton the anesthetic 
effects of chloric ether. One day in July, 1844 he gave 
a patient chloric ether and proceeded to fill a tooth, 
Morton became deeply interested and later learned from 
Jackson that sulphuric ether was also an amesthetic. So 
he administered it at once to a patient and extracted a 
deeply rooted tooth. After this Morton visited Doctor 
John Collins "Warren, of the Massachusetts General Hos- 
pital, and successfully urged him to give the new anes- 
thetic a trial in surgical eases. He did not, however, dis- 
close the name of the drug. The first operation took 
place at the Hospital on October 16th, 1846. The case 
was a "congenital but superficial, vascular tumor, just 
below the jaw, on the left side of the neck." It took 
Doctor Warren five minutes to complete the operation. 
When the patient returned to consciousness he exclaimed, 
Gentlemen, this is no humbug." 

On November 18th, 1846, the discovery was announced 

the world in a paper by Henry J. Bigelow. It wa3 

published in the Boston Medical and Surgical Journal. 

Oliver Wendell Holmes, then professor of physiology 
and anatomy at the Harvard Medical School, proposed 
the terms "ansesthesia" and "anesthetic", which terms 
are in general use to-day. 

On January 19th, 1847, Sir James Young Simpson, 
professor of Obstetrics at Edinburgh, used ether in con- 
finement eases. This was the first use of ether in ob- 
stetrics in Great Britain. On November 4th, 1847, he 
stopped using ether and in its place used chloroform. 
Chloroform so impressed Simpson that he published a 
paper, telling of his results, a week later. 



After Doctor Simpson used an amesthetic in the case 
of Queen Victoria, a controversy arose over the use of 
ether and chloroform. This controversy was mainly re- 
ligious in character. In a short time however the use of 
anaesthetics in childbirth became the custom. It was a 
giant step in the direction of better work on the part of 
the doctors. "Women were spared the shock attendant 
in many eomphcated cases. The doctor could wait, in 
certain types of eases, and at the proper time administer 
ether or chloroform, and get a living child, as well as save 
the mother no end of suffering. 

It was natural, therefore, that it became the custom 
to administer chloroform in small doses at the beginning 
and continuing through each pain, to the mother. The 
small, intermittent dosage of chloroform, given in this 
manner was called, "Chloroform a la reine." It had a 
vogue for two generations. It had many disadvantages, 
however, and in time became a rarity. But Simpson had 
opened a new horizon to the physician. He had proven 
that much of the pain attendant upon childbirth could be 
lessened. Because of anssthesia surgical obstetrics be- 
came possible. Because of anesthesia the Ciesarean sec- 
tion has become commonplace among surgical operations. 
Thanks to anstethesia many women are delivered of liv- 
ing babies with little injury to themselves while previous 
to the days of ansesthesia both mother and baby might 
have died. 

Since the days of "Chloroform a la reine" anffsthetiee 
have been given, in many different combinations and 
ways, in childbirth. And with anjesthesia in labor has 
been ushered in an abuse. Before ansesthesia was uni- 
versal the expectant mother was given a full test of labor 



J 



TcEB Evolution of Twilight Sleep. 21 

before interfering with the birth. After anaesthesia be- 
came the rule ia labor cases the average physician saw 
in it a saving of time, instead of giving a patient the 
full test of labor, in his eagerness to save time, many 
doctors administered chloroform or ether and delivered 
the child with forceps. Often the indiscriminate use of 
forceps wrought great injury to the child and rendered 
the mother a physical wreclt. And so to-day the skilled 
worker in obstetrics is guarded and careful in hie use of 
forceps for, full well, he knows the dangers attendant 
upon their apphcation. 

Anaesthesia, however, soon became the custom only in 
cases reqmring surgical interference. By this I mean 
the application of forceps, manipulations changing the 
position of the child and thereby making a normal birth 
possible, and in major operations, such as a Ciesarean 
section, etc. It was observed that in long, drawn out 
cases, the woman in her efforts to give birth to her off- 
spring, often suffered uimecessary pain. The pain was 
not in proportion to the contractile power of the womb. 
The muscular contractions of the womb became feeble 
but the pains stiU continued in their severity. To meet 
this condition it became the custom to administer to the 
patient a narcotic, such as morphine or chloral. It was 
learned that the patient fell asleep or experienced a 
needed rest, the uterus later contracted with the desired 
force, the cervix (neck of the womb) more easily dilated, 
and in many cases a normal birth resulted. Some physi- 
cians went further than this. They made a routine of 
giving the patient chloral or morphine, and injecting 
atropine into the cervix, in slow labors. This gave the 
womb a rest and made the neck of the womb more easily 
dilatable. 



i 



Twilight Sleep in Ameeica. 

ince the days of "Chloroform a la reine" 
been a universal custom. If, after the use of morphine or 
chloral, or some other drug, a certain time passes and 
the child is not horn, then an anesthetic is considered 
and given, in the majority of cases. 

Pain in childbirth still continued the dominant factor, 
however, although an anesthetic or a narcotic was given. 
Like the primitive people or the women of savage tribes, 
here and there, would be and is a woman who either suf- 
fered little or no pain or else did not appreciate the pain. 

Every woman knows, who has borne children, and 
every doctor knows who has attended confinement cases, 
that it is the dread of pain and the memory of the suffer- 
ing attendant upon childbirth that makes it a dreadful 
ordeal. 

Then the last crowning achievement in the art and 
science of obstetrics became a reality. 

The psychology of the evolution of Twilight Sleep we 
may never know. Possibly it was due to a combination 
of past events. The discovery and use of anesthesia, 
the administration of quieting drugs, . . these factors 
play star roles in the evolution of this last triumph. 

After years of patient labor and persistent experi- 
mentation, it was found that scopolamine and morphine, 
used in definite doses, regulated according to the case at 
hand, caused a diminution of the pains of childbirth, but 
better still, caused an apperception of pain. Twilight 
Sleep, successfully administered, is really the lack of 
memory of pain. 

The first to test this method in childbirth was Dr. Von 
Steinbuchil, at the time connected with the Freiburg 
FrauenkUnik. Later Bernhardt Klronig, a gynecologist 



The Evolution of Twilight Sleep. 23 

of Jena, with Dr. Karl Gauss, perfected the technique, 
now followed. 

It is to these men and their associates, that Twilight 
Sleep has been perfected and to them that we have defin- 
ite rules to work by and a technique, in detail, whereby 
in America and elsewhere it may be successfully given. 



Twilight Sleep in Amebica. 



I 



Twilight Sleep. 

if an advertiser had been seeking a fit term for a brand 
of goods, in order to advertise them, he could not have 
been more successful than were our German friends in 
choosing the term, * ' Dammerzustand " or " Dammer- 
sohlaf". "Daminerschlaf" was not the result of long 
cogitation but describes the state of the mother while in 
labor. This idiom inaecurately translated into English 
has been termed "TwiUght Sleep". It has become uni- 
versal. Better than any other phrase it describes, in a 
terse way, the whole condition. 

A mother in the "Twilight" state is neither conscions 
nor unconscious. She is not really in a state of semi- 
consciousness, although this is about the condition pre- 
sented. It is a sort of between darkness and dawn state. 
The mother, as a rule, falls asleep between her pains. 
During the pains she seems conscious and gives express- 
ion to her suffering the same as any woman not in the 
"Twilight" state. If the patient remains in a deep 
sleep and gives no evidences of feeling pain she is too 
far under the influence of the drug. This condition is to 
be avoided. It is a dangerous condition both to mother 
and child. But of this we will speak later on. 

Two drags are used to produce the state of the mother 
known as "Twilight Sleep", They are Scopolamine and 
Morphine. 



Twilight Sleep. 25 

There is no "secret" to the technique of administer- 
ing these drugs. But the operator must possess a sixth 
sense, either inherent or acquired, and know his case. 
There is a formula for the amounts of the drugs to be 
given and at what intervals of time to administer them. 
This formula has been devised by the patient workers at 
Freiburg and found to suit the average case. Every 
case, however, is not the average. One woman will re- 
■quire twice as much of the drugs as the next woman and 
that woman but half the dosage of the first woman. 

Up to the present the German preparation of the drugs 
has given the best results. It may be that by the time 
this is before the reader the American chemists will have 
produced a still better preparation. It remains a fact, 
however, that by those who had success in the first cases 
of "Twilight Sleep" in America, the German prepara- 
tion was used. The failures, and they were in no small 
number, have been ascribed to other preparations. 

In order to get a clear idea of "Twilight Sleep" an 
ideal ease delivered by this method will be cited. 

The woman entered the hospital at 8 a.m. She was 
an American by birth. Temperament nervons. She had 
read of Twilight Sleep and had been admitted to the ma- 
ternity ward asking, if possible, to have that method used 
in her case. 

She had had one child. It was bom dead. She had 
a keen recollection of the suffering she endured in that 
first case. She described it as a living purgatory. She 
prayed she would never again become pregnant. When 
she realized that she was to have another child she nearly 
became "crazy". "With the apprehension of future suf- 
fering her mental state was beyond description. 



I 

t 

I 



26 Twilight Sleep in Ambeica. 

And so she entered the hospital hoping against hope 
that all she had read of Twilight Sleep was true. 

She was admitted to a small room in a quiet corner 
of the building. She removed her clothes and donned a 
dressing sack. She was not put to bed. Her pains were 
feeble and occurred at long intervals. 

The house doctor took her measurements, history, and 
a complete physical examination was made. There being 
no reason discovered why she shouldn't be "Twilighted" 
she was told that she would have her baby in good time, 
that it would be a normal case unless the unforeseen hap- 
pened, and that as soon as her pains became "real" the 
visiting obstetrician would be called and the first injec- 
tion of the drugs given. 

About twelve thirty o'clock, noontime, she was having 
fairly strong pains. 

She was put to bed. The room was made as sound- 
proof as was possible. Beyond being told to have no 
fears for the future nothing further was said to her. 

The visiting obstetrician ordered the first dose of Sco- 
polamine and Morphine given. These are given sepa- 
rately. These drugs are in solution and are adminis- 
tered hypodermically. They are injected in the thigh 
near the hip. 

In a short time the patient complained of great thirst. 
The Scopolamine causes this condition. Water was 
freely given throughout the entire case. Food is with- 
held, however, while in the Twilight state. 

In about fifteen minutes she said she felt drowsy. 
Shortly after she fell into a light sleep. She was easily 
aroused. By calling her by name, in an ordinary con- 
versational tone of voice, she would open her eyes and 
answer. Her face was flushed. 




When she felt a pain she compressed her lips and 
moaned feebly or tossed about in the bed. Under ordi- 
nary conditions a woman of this type would have 
screeched with the pain and begged the doctor to "do 
something". In this case as soon as the pain ended she 
closed her eyes and was again in a light sleep. At times 
she opened her eyes and asked for a glass of water. 

At stated intervals injections of Scopolamine were 
given. The Morphine is used with the first injection but 
not repeated for several hours, as a rule. Some only 
give it once. It depends on the case at hand. 

As the labor progressed and the nterine contractions 
became stronger she gave expression more forcibly to 
the pain. 

Several physicians were in attendance, seeing "Twi- 
light Sleep" for the first time. When the patient would 
moan and ask such queries as, * ' How much longer ? " "Is 
it nearly over?" these doctors were seen to exchange 
meaning glances and the operators knew that their faith 
in "Twilight Sleep" was waning fast. 

"Is this the real state of Twilight Sleep!" one physi- 
cian asked. He was given an affirmative answer. 

"Then what benefit does the patient derive?" asked 
another. 

"She loses the memory of all preceding pains. She 
is living only the present moment. Impressions beyond 
twenty minutes are blanks," was the answer given. 

And so a series of memory tests were given. These 
memory tests are the crux of the situation. She had 
been examined four times. When asked how many 
times she had been examined she mumbled, "One, I 
think." 



28 TwnjGHT Sleep in Ameeica, 

"How long have you been in this rooml" she was 
asked 

"About half an hour." 

8he had entered the room at 8 a.m. It was then 
nearly six p.m. 

At 8.20 p.m. she gave birth to a live male baby weigh- 
ing seven and three-quarters pounds. 

Purposely many things that make for a successful case 
have been omitted in this report. 

Near the end, to the experienced physician in obstetric 
work, she resembled a normal ease. She cried out with 
the pain and begged to be relieved. As soon as the pain 
ended, however, instead of giving the appearance of 
complete exhaustion, she fell asleep and remained quiet 
until the next pain awakened her. 

With the birth of the head she was given a light ames- 
thetic. Some make it a routine to give an anesthetic aa 
the head is bom. Some dispense with this routine. In 
this case a few drops of ethyl chloride were g^ven, using a 
specially devised mask. 

The baby cried as soon as it was bom. It was not 
blue. It looked as pink and robust as a baby bom under 
perfect conditions by the "Old Method," 

The mother was made comfortable. The baby was re- 

I moved, at once, to the baby ward. It has been learned 
that the sudden cry of a baby, after birth by the "Twi- 
light Sleep" method, often is heard by the new mother 
and is the thing that remains in her memory. 
Three hours later the mother was awake and aU effects 
of the drugs had worn off. She was conscious. She 
asked when the baby would be born. 
A nurse told her that they expected the baby in two 
or three hours. 



I 



Twilight Sleep. 

"What makes it so dark?" the mother replied. 

"It is after midnight", the nurse replied. 

The patient seemed bewildered. She passed her hand 
over her abdomen. A hopeful light came into her eyes. 

Lookiiig expectantly at ibe nurse, she asked, "Is it 
true!" 

"Of course it is," from the nurse. 

"What is it?" 

"A boy — Now, don't ask questions, but go to sleep." 

Do not form the impression that every case of "Twi- 
light Sleep ' ' has such a perfect ending. 

In Germany it has been reported that an average of 
from 60 to 80 per cent of the cases are successfully twi- 
lighted. 

After a sufficient amount of the drugs have been in- 
jected and the operator appHes the memory tests and 
finds that the patient has not responded to the drugs, no 
further injections are given. This type of case is not for 
Twilight Sleep. 

The practiced obstetrician who has had experience 
with these eases must use his judgment as to the dosage. 
Too much of the drug may cause endless harm. Too 
little of the drug given, or given at long intervals of 
time, cause what are termed, "isles of memory." These 
"isles of memory" are to be avoided. To give an ex- 
ample of the meaning of this term. The patient has 
been in labor two and a half hours. She has had one in- 
jection of Scopolamine and one injection of Morphine. 
Three quarters of an hour later she responds to the men- 
tal tests. The operator knows that the patient is re- 
sponding to the drugs and in the proper state of Twi- 
light Sleep. But the effects of the drug wear off and 
suddenly she appreciates her true state. The operator 



rwHJGHT HLBBP IN 



Ambi 



realizes that she has "come out from the effects of the 
drug" and orders further iujections. From then on the 
patient has no memory of what takes place. After all is 
over she will retain the memory of what took place houra 
before while not under the influence of the drugs. The 
fewer these "isles of memory" the more successful the 
case. If a patient is not "Twilighted" successfully she 
will have many of these "isles of memory" and later on 
patch them together, making a "whole carpet" of the 
pieces, and declare she knew all that transpired. 

From reports we know that there is no average time 
for a ease of Twilight Sleep. Some cases have not lasted 
two hours. We know of, at least, one case that was kept 
in the Twilight state twenty-nine hours. This case was 
successful. 

Although a patient may be the proper type for Twi- 
light Sleep and physically there are no contra-indica- 
tions to this method, it does not follow that the birth will 
result in a normal one. 

This the public has been led to believe through maga- 
zine and newspaper accounts. Malpositions of the foe- 
tus in utero (child in the mother) have to be met and 
remedied the same as in a case not conducted according 
to the methods of Twilight Sleep. Versions, forceps, 
breech extractions . . all are possible and cannot be 
avoided. 

It is true that there are certain distinct advantages of 
this method besides the lack of appreciation of the 
memory of pain. But these will be considered in another 
chapter. 

To have a successful termination of a Twilight Sleep 
ease certain refinements must be followed. 



TwnjQHT Sleep. 31 

. bright light must not shine in the patient's eyes. 

The patient must not be exposed to external irritation. 
All lights in the room should be subdued and shaded. 
Some operators, in order to make sure on this point, 
have the patient wear colored glasses. 

Unnecessary or sudden noise is to be avoided. For 
this reason the nurses and doctors wear rubber soled or 
felt shoes. In order that no noise disturb the patient, 
and so cause an "isle of memory", oiled cotton is placed 
in the patient's ears. 

Soon after Twilight Sleep was practiced in this coun- 
try the question as to whether it could be successfully 
carried out in a patient's home became subject to debate. 

It was urged upon the profession that all Twilight 
Sleep cases should be reserved for a hospital. The rea- 
son for this is obvious. A Twilight hysteria was sweep- 
ing the land. Every pregnant woman was calling on her 
physician asking about painless childbirth and no few 
demanded to be delivered a la Twilight. 

Twilight Sleep was on trial. Reports of repeated un- 
successful cases meant that Twilight Sleep would be 
doomed. The specialist wanted to avoid this and give it 
a fair, scientific trial. 

Doctors flocked to maternity clinics eager to see a 
TwiUght case. Many bought the drugs and feeling se- 
cure, that in the near future they would be experts, en- 
gaged Twilight Sleep cases in their private practice. 

Guarding against failure by the inexperienced it was 
preached that the only place for a Twilight case was a 
well equipped hospital. 

To name the hospitals in which Twilight Sleep eases 
have been conducted would be to list every important 
hospital in the country. 



Twilight Sleep having been tried and found successful, 
the specialist began to extend his work to include cases 
conducted in the patient's home. To-day, hundreds of 
physicians are skilled in the art of this method, and to 
the profession, a Twilight ease excites but a passing in- 
terest. 

A well equipped institution is the ideal place for any 
pregnant woman to give birth to her child. Alas the 
ideal is not always possible. Many live far from, hos- 
pitals or feel that they can eeomonize by remaining home. 
For the ordinary case this is good and well. The pa- 
tient and the physician should think twice, though, before 
deeiding to have the lying-in room in a private dwelling 
in a case of Twilight Sleep. 

Twilight Sleep, at the present, is for the very poor or 
the rich. In large cities the poor can have free board 
and the attendance of experienced obstetricians. They 
get the benefit of the latest and best methods. Hospitals 
are always open to them. 

The wealthy get no better attention. Certain luxuries 
are within their means. In hospital work these luxuries 
are the only difference between the two extremes of so- 
ciety. 

It is of the great middle class that the obstetrician 
most often comes in contact. 

Unless the patient (one of this middle class) can af- 
ford to engage a trained nurse, or possibly two at the 
time of the delivery, Twilight Sleep should not be at- 
tempted in the home. A tenement is no place for the 
successful handling of a case conducted according to this 
new method. 

As a rule the patient who can afford to engage a physi- 
cian to give Twilight Sleep has the means to engage 





trained nurses and lives in surroundings that may be 
adapted to this method. 

A busy obstetrician cannot practice cheap Twilight 
Sleep. Unlike the average case he cannot see the pa- 
tient and then leave giving instructions when he is to 
be called. Once he begins a Twilight Sleep case, either 
he or his assistant, must be in constant attendance. The 
time in all obstetric cases cannot be foretold. And so it 
happens that the doctor remains with the patient for 
many hours. Naturally he must be compensated for this 
time. No branch of medicine is more poorly paid than 
that of obstetrics. People who gladly pay a handsome 
fee for a simple, uncomphcated case of appendicitis op- 
erated on, grudgingly pay a sixth or an eighth of that fee 
for an obstetric delivery. For this reason the general 
practitioner has not taken kindly to Twilight Sleep. The 
specialist who has demanded and is paid a fair compen- 
sation for his work naturally comes in contact with the 
class of people who make it possible for him to spend the 
slowly passing hours on a Twilight Sleep case. 

This is an unfortunate economic condition, but is true. 
In towns and cities the average woman of small means is 
in better hands in a hospital, especially if it be her first 
baby, than engaging a doctor whose main idea is to "get 
the case over with", collect a few dollars, and leave the 
damage done to a future date and a different physician. 



k 



34 



Twilight Sleep in America. 



Twilight Sleef^Pbo and Con. 



A well known obstetrician speaking before a large aud- 
ience was asked as to the dangers of Twilight Sleep. He 

answered: "I have been asked to discuss the dangers of 
Twihght Sleep, but I cannot do that for I know none. 
There should be no danger when competent physicians 
and nurses are employed. All drugs contain poison, but 
I have not seen a single untoward symptom in any of 
more than 250 cases with which I have had experience." 

This, from an authority, is true of other workers. 
I "What are the objections to Twilight Sleep? 

I will not discuss whether God intended women to suf- 
fer during childbirth. Science does not deal with the 
sentimental. It treats of facts. Suffice to impress the 
fact that there are some women who suffer Uttle or no 
pain during their delivery. This is also true, as a rule, 
among the women of savage tribes, as we have learned. 
If God decreed that women should bear their offspring 
with pain, why are certain women excluded from this 
general rulef 



Twilight Sleep — Pbo and Con. 35 

Civilization, not nature, through the evolution of long 
periods of time has changed women from simple into 
complex beings. And with this change pain has become 
a factor in labor cases. 

It is dangerous to the mother. 

A common objection. A man with a broken leg is suf- 
fering great pain. The doctor in charge gives the patient 
a dose of morphine. The pain is lessened. Where is 
the danger ? In an over dose 1 Naturally. The same is 
true of the drugs used to produce the state known as Twi- 
light Sleep. Gfive too little and there is no effect. Give 
too much and the patient and baby may be placed in a 
dangerous condition. Therefore if used by a competent 
physician this danger is overcome. 

It is dangerous to the baby : 

A most serious objection. As a matter of fact the 
records of thousands of cases of babies bom at Freiburg, 
Germany, by the Twilight method, show that the infant 
mortality is decreased. 

From reports of American physicians, using this 
method, the results show that there is a decrease in the 
number of babies born dead or dying shortly after birth. 

Babies were bom dead long before "Twilight Sleep" 
was ever thought possible. Many conditions make for 
dead babies as, syphilis, long protracted labors, eclamptic 
convulsions of the mother, hard forcep deliveries, the pla- 
cental cord getting into a knot or twisting itself about 



36 



TwiLiOEX Sleep if Amebica. 



the child's neek, hard breech deliveries, etc. These are 
some reasons why babies do not live. 

In other countries, Germany especially, when a baby 
is born dead an autopsy is made. From this work it has 
been learned that many conditions cause death of the 
child at birth or soon after birth. Among causes of 
death may be mentioned, lack of certain vital organs, dis- 
placement of organs, internal hemorrhage, or some con- 
dition over which man has no influence. Therefore Twi- 
light Sleep or the doctor in charge should not be held re- 
Bponsible for the death of the baby. 

Before the advent of Twilight Sleep these facts were 
recognized and appreciated. Since Twilight Sleep, its 
opponents place the blame of every still-birth on this 
"new foreign method." 

It is true that a too large dosage of the drugs may 
cause the death of the fcetus, or cause it to be bom blue 
and therefore hard to resugitate. But the Twilight meth- 
od properly carried out gives as good end results to the 
child as when it is not used. 

It makes dope-fiends of the patients 1 

This is a far fetched objection. It is admitted that 
doctors giving their patients "dope" on all and every 
occasion have made "drug fiends" in many instancea. 
The use of morphine and cocaine has been responsible 
for this state. In Twilight Sleep, however, the patient 
-Ass no memory of any but the first injection. AH anbse- 



i.* 



TWTEJOHT Sleep-^Pho ahd Cott. 

quent injections are not appreciated. Does it seem likely 
that the new mother after the birth of the child, will 
erave a drug which causes nothing but lack of memory! 

'^Women are made insane from the drugs ! 
'ne morning this statement was made in a New York 
paper. A prominent physician was quoted. Invited to 
attend a meeting of a medical society to discuss the sub- 
ject, he was unable to attend, but sent a letter denying 
that he had ever made the statement that Twilight Sleep 
caused insanity. 

That there is a type of insanity that follows or accom- 
panies child-birth is known. Every obstetrician has met 
with these cases in private and hospital practice. I have 
been unable, however, to find record of a single case of 
puerperal insanity claimed to have been caused by either 
of the drugs used in Twilight Sleep. 

Every objection to Twilight Sleep has been met and 
answered. It is known that xn proper surroundings, un- 
der the care of competent nurses and attended by skillful 
physicians the dangers attendant on Twilight Sleep be- 
came nil. 

The advantages are many. The lessening of the im- 
mediate pain, the wiping out of the memory of the suf- 
fering just past and the fear produced by it, naturally are 
its chief advantages. 

It prevents the offensive use of forceps. A physician 
better appreciates this statement. Forceps are a neces- 



38 Twilight Sleep in Amekica. 

sary evil. They have their place and rightly used are a 
blessing. 

No greater abuse has been practiced in the practice of 
obstetrics, than the faulty use of forceps. If it were not 
for the obstetric forceps the gynecologist would lose half 
the field for his work. A competent worker never abuses 
the use of his tools. Unfortunately many physicians are 
not skillful when they enter into the domain of surreal 
obstetrics. A delivery of a child with medium or high 
forceps is a surgical procedure. 

Forceps save time. Rather than remaining with the 
patient two or three hours the doctor can use "instru- 
ments" and be on his way in, possibly, half an hour's 
time. 

The result of this abuse is laceration. The neck of the 
womb is torn. The outlet of the birth canal is lacerated. 
This means a major operation sometime in the future. , 

Any object introduced into the womb from without is 
liable to carry with it infection. Even in cases where the 
strictest asepsis is observed blood-poisoning, after the 
use of forceps, may result. 

To be successful in eases of Twilight Sleep the opera- 
tor must be competent. Such a man is not likely to 
"spoil" his case by running unnecessary risks. A pro- 
fessor in one of the Eastern Medical Colleges is responsi- 
ble for the statement, "If Twilight Sleep does notliing 
^L else it will curtail the indiscriminate use of forceps." l 



I 



Twilight Sleep — Pho and Con. 39 

"it has been observed that in cases of Twilight Sleep 
there is no sudden expulsion of the head of the child. 
The process of birth is gradual. The maternal parts 
have time to accommodate themselves to new conditions 

and lacerations are lessened in severity and in number. 

In eases of pregnancy comphcated by heart disease 
Twilight Sleep is a distinct advantage. A physician lec- 
turing on Twilight Sleep before an audience of a thou- 
sand women was asked by a woman in the audience 
whether Twihght Sleep was suitable for women suffering 
from heart disease. 

"There are no cases," he said, "in which Twilight 
Sleep can be used with less danger and with more bene- 
ficial results than in that of women suffering from heart 
trouble. The great danger to women with heart trouble 
is the effects of shock and exhaustion, which are both 
greatly diminished by Twilight Sleep." 

In certain types of cases of toxemia of pregnancy it has 
been claimed that Twilight Sleep lessens the severity of 
the sequalffi. In the severe eases this is not held to be 
true. In fact it has been listed as a contra-indieation. 

The statement has been made that due to the lessening 
of shock to the nervous system Twilight Sleep mothers 
have richer and more milk I 

Later on we will see that Twilight Sleep babies, in 47%, 
have gained weight at the tenth day due to better feeding. 



^V 40 

^H It is true that the women post-partum are in better 
^H condition after having been Twilighted than are those 
^^1 ■women who have delivered without Twilight, 

^H A well known obstetrician, who had never seen Twi- 
^1 light Mothers after the birth of the baby, was being eon- 
^1 ducted through the maternity ward in a hospital. 

^H He was shown the "Twilight" mothers — "The fact 
^H that impresses me," he remarked, "is that these women 
^H look so fresh. They do not give the appearance of women 
^H who have gone through labor." 

^H The shock to the nervous system having been reduced 
^H to a minor degree, Twilight Mothers, a few hours after 
^H the birth of the child, are none the worse for their esper- 
^H ieuce. 

^H The drugs have no effect on the contractions of the 

^H womb. Bleeding post-partum is not so likely to happen 

^" and some physicians allow their patients to get out of 

bed on the third or fourth day. Some even permit this 

the day of the dehvery. This is given as a matter of in- 

I formation and need not be discussed in these pages. 
There are definite contra-indications to the Twilight 
Sleep method in obstetrics. The very young and the very 
aged should not be twilighted. This rule has been disre- 
garded without serious consequences. 
In cases where the pelvis of the mother is deformed, 
or where the doctor knows a surgical operation surely 
will be necessary, Twilight Sleep is out of the question. 




Twilight Sleep — Peo Am) Con. 

The hemorrhages of childbirth place the mother be- 
yond the pale of Twilight Sleep. 

Twilight Sleep should not be attempted in cases where 
a diagnosis of a dead fostus in utero has been made. The 
friends and family would be liable to blame the death of 
the child to Twilight Sleep. 

A well known obstetrician has defined Twilight Sleep 
as the application of partial narcosis to the most painful 
ordeal in a woman's life, in such a way as to eliminate 
the memory of subjective pain without interfering with 
the uterine (womb) contractions. A great many doctors 
have referred to this as the best definition, yet given, of 
Twilight Sleep. 

Going over the vast amount of literature upon this sub- 
ject, and most of it of recent date, the author will give 
short abstracts of the most important phases of this 
topic, as presented by these authorities. 

One writer says that the partial narcosis method of 
making the sufferings of childbirth less and in making it 
easier for the neck of the womb to dilate has been ef- 
fected for a great many years by the drop chloroform in- 
halation at the beginning of each pain, by injecting a full 
dose of chloral in the bowel and in administering mor- 
phine or one of the opium preparations. These methods 
have been a blessing especially to those neurotic women 
who cry aloud for help in this period when external in- 
terference should not be attempted except in the face of 
a grave complication. Every physician knows that these 



42 



Twilight Sleep in Amebioa. 



women tempt them and, the doctor weary with waiting 
and watching and exhausted from the loss of sleep, 
against his better judgment goes to these unprepared 
parts and the result is chronic invalidism and gynecologi- 
cal surgery in the future. 

The statement has been made that it is possible to re- 
move the suffering of childbirth in about 85% of all 



When scopolamine and morphine are used the neck of 
the womb dilates more easily. In the face of a dry labor 
(after the rupture of the membranes) tills dilation is 
more marked. 

A woman in the Twilight Sleep state exerts less muscu- 
lar effort. 

That the nervous shock is eliminated and that these 
women feel and look much better than after an ordinary 
labor has been demonstrated in thousands of cases. 

The contraction of the womb and adjacent structures is 
more rapid after a Twilight Sleep case as has been 
learned from the experience of many obstetricians. 

It was through public interest, aroused in the lay press 
and an American Magazine, that the medical world was 
forced to investigate the work of Kronig and Gauss. 
Many doctors from America journeyed to the little town 
by the Black Forest. The result has been the present ex- 
cellent work by American doctors with Twilight Sleep 
cases. 



Twilight Sleep — Pbo anb Cok. 43 

Inasmnch as studies show that it i8 possible to lessen 
the pains of childbirth and to cause a forgetfulness of 
what pain there was in about 857o of the cases in which 
the Twilight Sleep method was employed, it is the conten- 
tion of many men that a woman is entitled to the relief 
of pain during labor, if it is possible for her to be Twi- 
lighted, provided she is exposed to no undue risk or the 
unborn child is not liable to harm. 

A professor of obstetrics claims that after twenty 
years of consultation work in New York he is of the opin- 
ion that labor is anything but a normal and physiological 
process. He claims that over 50fo of all gynecology 
(diseases of women) is the result of badly conducted nor- 
mal labor. To his mind poor diagnosis in confinement 
cases is more frequent than in any other department of 
medicine and surgery, except perhaps cancer. 

The fact that there are dead and mutilated babies, or- 
gans torn and puUed out of place, chronic invalidism and 
infection, are named as some of the causes which have 
produced the great public demand for Twilight Sleep. 

One doctor says that it is especially indicated in ner- 
vous women in their first labor. These are the women 
who, as a rule, are given an anaesthetic and delivered 
with forceps. These "physically unfit" are benefited by 
scopolamine and morphine. 



44 Twilight Sleep in Amebioa. 

There is no better way to end this chapter than to 
quote a doctor who has had a large experience with Twi- 
light Sleep in America. He said, * * The more I see it the 
more I am impressed by it. To me Twilight Sleep is a 
reality. ' ^ 



The Futtjee and Twilight Sleep. 



The Future ahd Twilight Sleep in America. 

So many facta were learned by American physicians 
about Twilight Sleep during the first few months, it is 
difficult to foretell what the future will bring forth. 

It was learned that smaller doses of the drugs would 
give as satisfactory results as the dosage recommended 
by the German workers. Early in the work it was 
thought that speciaDy equipped wards and delivery-rooms 
were essential. As this would take time and money the 
early cases of Twilight Sleep were conducted ia the pri- 
vate rooms of the hospitals. They were successful. A 
room removed from the noise of the streets and away 
from the noises of the building was found to answer all 
purposes. 

In Germany the nurses, specially trained, administer 
the drugs and notify the attending physicians at certain 
times regarding the progress of the case. In America 
sufficient time has not passed to instruct the graduate 
nurse or the nurse in training to do this work. Many 
hospitals are working along these lines, however, and in 
time there will be many nurses competent to handle these 



^ 




I 

I 



Twilight Sleep in America. 

cases. Until that time the doctor in charge will continue 
to do all the work. 

In America the dosage, the symptoms, the indications 
for and the contraindications, have been standardized 
and in many hospitals the internes (house doctors, ns- 
ually recent graduates) conduct all but the private cases. 
These internes, in a few months, enter the actual prac- 
tice of medicine. Having been schooled imder the direct 
supervision of the attending obstetricians, as soon as they 
begin the actual practice of their profession they will be 
skilled in the art of Twilight Sleep. These men, the men 
who visit clinics to learn the Twilight Sleep technique, 
and the visiting obstetricians of the hundred of hospi- 
tals of America, will number into the thousands. And so, 
unless a better method is devised, Twilight Sleep will be- 
come the routine method, in cases in which it is indicated, 
in America. 

A prominent obstetrician and gynecologist before an 
audience of doctors said that he had gone twice to Frei- 
burg. He said that from his close contact with Profes- 
sor Kronig and Dr. Gauss he had received some very def- 
inite impressions. About two years ago some physicians 
attempted this method but with poor results. Since then 
the workers in Freiburg have perfected the method. He 
warned the profession to remember that many fake 
cures had been fostered on the American public through 
newspaper hysteria, but in the case of painless labor it 
was necessary for the expert to give it a fair trial before 
Hie profession, as a whole, should attempt it. 



The Future and Twilight Sleep. 47 

He ended Ms long discussion by saying that to his 
mind Twilight Sleep marks one step further toward the 
obstetric inevitable. He urged that the doctor with spe- 
cial obstetrical training was the only one who should at- 
tend a primipara. (Woman with her first baby.) 

Since Twilight Sleep was introduced in America it has 
not been an infrequent experience to hear of certain set- 
tlements where the doctors for years have practiced a 
form of painless childbirth. Upon investigation these 
facta cannot be substantiated. 

Another fact that has been given space in the news- 
papers of the country, is that there are better drugs or 
combinations of drugs to induce the Twilight state than 
the accepted Scopolamine and Morphine. Physicians 
have had formula of drugs published and have claimed 
that, for years, these drugs have been used and with suc- 
cess. A book of this sort is not to debate such ques- 
tions. All these doctors claim may be true. It is a rec- 
ognized fact among physicians, however, that the one 
who first publishes a new method, gets the credit for the 
method. We have known about Twilight Sleep for years. 
If a physician has practiced a method of his own for 
several years and found it successful, this is a late day to 
rush into print and seek glory for himself and bis own 
method. 

The majority are of the opinion that it is better to try 
out one accepted method and master it before experi- 
menting with untried methods. 




i 



48 Twilight Sleep in Amebica. 

Will the present method be improTedt It is a preva- 
lent opinion that it will be bettered, rendered safer, easier 
to give, and within the province of the physician of all 
degrees of training to practice Twilight Sleep in his work. 

From France a new and a better method is claimed. 
One American obstetrician has given this method an in- 
different trial and reported his results, which were satis- 
factory, in a prominent medical journal. 

On July 21st, 1914, Professor Eibemont Dessaignes of 
the French Academy of Medicine delivered an address on 
painless childbirth. 

In 112 labors he used a morphine preparation, the dis- 
covery of a chemist, George Paulin. Paulin and Doctor 
Pierre tried the new drug on animals and finding it safe 
recommended it to Eibemont. In his report 84 cases 
were in a state of complete analgesia, 24 cases in marked 
but not complete analgesia and 4 patients claimed no re- 
lief. The analgesia lasts from 30 minutes to 12 hours. 
Sixty three cases needed but one injection. Thirty-nine 
became painful at the end of five hours. Nine cases re- 
quired three injections. One case was injected five times. 

Of 112 labors 115 babies resulted. Seventy-seven cried 
at once. Twenty-eight were "dazed" at birth. One was 
bom dead. 

It has been hard for American doctors to get this drag 
and little or no work with this preparation has been at- 
tempted in America. Therefore we must withhold judg- 



The Futube and Twhjght Sleep. 49 

ment until a future time when this ideal method, if all is 
true that is claimed for it, is thoroughly tested by Ameri- 
can experts. 

Many women have asked their doctor: "If your wife 
was to have a baby would you encourage Twilight Sleep?" 

This is a test question. It strikes at the heart of the 
situation. Many doctors of fine balance, in their enthu- 
siasm, are liable to practice methods in their routine hos- 
pital work that they would hesitate using on one of their 
own. 

Therefore the writer asked this question of physicians 
whose knowledge and experience with Twilight Sleep 
made them competent of giving a satisfactory answer. 
All answered the question in the affrmative. The sum 
total of their answers were, "It's safe. It's practical. 
"Why not f" 

A Brooklyn doctor wrote to the more prominent obstet- 
ricians throughout the United States asking them to fill 
out an enclosed blank on their work on Twihght Sleep. 
From some thirteen hundred eases reported he tabulated 
one thousand cases and for comparison took hospital rec- 
ords of a thousand cases delivered by the usual methods. 

The figures presented by this physician are of vital in- 
terest. The writer would like to refer to this doctor by 
name as the statistics he has given to the medical world 
have had a great influence on Twilight Sleep in America. 
As the author has made it hie rule not to mMitaqn _tiy-. 



50 Twilight Sleep ik America. 

name any American doctor in this book, much to Ms re- 
gret, he must adhere to his rule in this case. 

This doctor reported that of the 1,000 cases not Twi- 
lighted, 392 were of women having a baby for the first 
time, and the balance, 608 were women who were already 
mothers. 

A woman about to have her first child is called a primi- 

para. A woman who has had children is known as a mul- 
tipara. Hereafter we will nse these terms. 

Of 1,000 women who had babies in America by the Twi- 
light Sleep method, 698 were primpara and 302 multi- 
para. 

Reports showed that of the Non-twilight Sleep cases 
73.9% of the primipara had spontaneous labors. 86.1?^ 
of the multipara were spontaneous births. 

Of the 1,000 Twilight Sleep eases 78.36% primipara and 
89.73% multipara had spontaneous deliveries. 

What do these figures mean? 

They show that of the primipara about 5% and of the 
multipara about 3% more of the Twilight Sleep cases had 
natural deliveries and without the aid of instruments. 

Turning to the cases that required operative interfer- 
ence the Non-twilight Sleep primipara averaged 26.1% 
and the multipara 13.9%. 

The Twilight Sleep cases resulted in 20.9% of priim- 
para and 10.27% multipara who required operative 
. measures; : -■ : ; 



The Futttrb and Twilight Sleep. 51 

ihese figures show that comparing 1,000 cases of each 
method the Twilight Sleep cases have a lower percent, of 
surgical interference. 

We now arrive at still more interesting figures for they 
deal with much that has filled page after page of the 
newspapers and been the cause of endless contention and 
fruitless discussion. 

Of 1,000 cases of Non-twilight Sleep cases one case died 
on the tenth day. There was not a death reported of the 
1,000 Twilight Sleep cases. 

We have read much of insanity caused by the Twilight 
Sleep method. One case delivered normally (not Twi- 
lighted) was melancholy on the sixth day. One Twilight 
Sleep ease (of the 1,000) gave evidences of a depressive 
melancholia. This means that the Twilight Sleep drugs 
have no mental effect on the patient. Out of a clear sky 
a woman before or after the birth of her baby may sud- 
denly go insane. This has been the experience of obstet- 
ricians for many years. Puereperal insanity it is termed. 
If figures mean anything we can readily see that scopo- 
lamine and morphine do not produce this condition. 

Bleeding after the birth of the baby, a serious condi- 
tion and often resulting in death, showed 1.7% in the 
Non-twilight Sleep cases and .%% in the Twilight Sleep 
cases. Many doctors have claimed that the drugs used 
to induce Twilight Sleep make post-partum hemorrhage 
more likely. These figures disprove this contention. 

Tears or lacerations resulting from childbirth mean a 
great deal to mothers. All lacerations of any ay^recvar 



i 



I 



I 



ble degree call for surgery. The reports of 1,000 eases 
of deliveries not Twilighted in the primipara showed that 
91% suffered lacerations. Dwell on these figures. Of 
the multipara 46.9% suffered fresh or added lacerations. 
Of the 1,000 women of America who have had Twilight 
Sleep 25.1% of the primipara suffered lacerations and the 
multipara 3.28%. 

Therefore 68.9% of the cases not Twilighted suffered 
lacerations, wliile 14.2% of the Twilight Sleep eases were 
lacerated. This difference (54.7%) shows one great ad- 
vantage in favor of Twilight Sleep. 

Eighty-six per cent of the Twilight Sleep cases had a 
PAINLESS LABOR. 

Of the babies bom by both methods the infant mor- 
tality was decreased 10% in Twilight Sleep eases. 

After the birth of the baby the following figures are of 
interest : 

WITHOUT TWILIGHT BLEEP. TWILIGHT SLEEP, 

Spontaneous Cry. ...78.6% 79.9% (Increase) 

Oligpncea 5.8% 14.6%) (Increase) 

Asphyxia 3.6% 3.6% (No difference) 

Still birth 2.5% 1.9% (Decrease, but 

in all fairness these still-birth figures have little mean- 
ing). 

Of 951 babies bom of Twilight Sleep mothers 454 of 
this number had gained in weight on the day the mothers 
Hne discharged. 



The Futube and Twilioht Slbep. 



53 



Some say figures have no value. To these, scientific sta- 
tistics have no meaning. The only way we can compare 
Twilight Sleep eases with those not Twilighted is by tak- 
ing hundreds of cases and showing percentages. To the 
fair minded the preceding figures all speak well for Twi- 
light Sleep. Other doctors are tabulating figures and in 
the near future, probably by the time this small book is 
published, five thousand or more Twilight Sleep cases will 
have been reported. These figures, however, that the 
Brooklyn doctor has given to the medical world are the 
first to date that have been tabulated of the Twilight 
Sleep cases in America. 

Prom an economic standpoint Twilight Sleep means 
more babies. The more intelligent members of our pop- 
ulation are the ones who, througli the fear and dread of 
bearing children, practice race suicide. These are the 
women who should have large famiUes. Once Twihght 
Sleep becomes the custom these women, now sterile from 
choice, will do their part in populating the earth. 

A Cleveland doctor, noted for Ms work on shock, has 
shown that violence, insomnia, and anxiety are three 
great contributing factors in the production of shock. 
Twihght Sleep has a tendency to ehminate insomnia and 
anxiety. As we have learned, the mother also escapes a 
disagreeable experience, and all violence in connection 
with the birth of the baby is banished from her memory. 

A doctor speaking before the New York Academy of 
Medicine said he had gone to Freiburg rather prejudiced 



M 



164 Twilight Sleep hj- America. 

against TwiKght Sleep, but that he was rapidly converted 
and had become very enthusiastic, and the enthusiasm 
of the women who had received the treatment would 
rapidly convert one to champion its use. 

The following is quoted from a paper published in the 
Medical Record, issue of January 23rd, 1915: "I flrmly 
believe this (Twilight Sleep) treatment of labor to rank 
as one of the greatest advances in medicine, as well as 
one of the greatest boons to the race, largely because it 
promises for a better race." 

The lay-press has written of cases of major operations 
performed by the Twilight Sleep method. The public 
asks if this is possible. 

It is . . but the method is far from new. In fact, the 
use of scopolamine and morphine in surgery antedates 
the Twilight Sleep method as related to obstetrics. 

A paper was published in 1905 on scopolamine-mor- 
phine anEesthesia in surgery. In the February, 1908, 
number of the American Journal of Obstetrics, was pub- 
lished an article, ' ' Scopolamine-Morphine AnEesthesia in 
Gynecology", the writer reported the results of this 
method in 185 surgical cases. 

One sentence of this paper is interesting inasmuch as 
he could have been writing of the Twilight Sleep of to- 
day. The writer said: "Many gynecological cases were 
operated on with other methods of amesthesia, not be- 
cause I considered scopolamine-morphine contraindi- 



The Futxjbb and Twilight Sleep. 55 

cated, as I recognize no contraindication except extreme 
youth, but because of external conditions, as lack of time 
or the patient ^s or the patient's physician's objection to 
the scopolamine-morphine on account of some gossip or 
some alarmist report in the literature. ' ' 

A physician said: ** There are great things in store 
for the mothers of to-morrow. ' ' Part of this has already 
been realized. 



Twilight Sleep rN America, 



CHAPTER 6. 



I 



The Twilight Sleep Babt. 

It has been written that there is a difference between 
Twilight Sleep and other babies. We have been in- 
formed that they are brighter, that they grow up health- 
ier, that they are prettier than are the babies bom ac- 
cording to the "old method". These facts appeal to the 
mother. 

Twilight Sleep babies are in no wise different from 
other babies. Any child born of healthy parents, prop- 
erly nourished and cared for will be a robust child. A 
healthy baby is a good baby. It is eommonsense that 
drugs given the mother for a few hours before the baby 
is bom cannot transform the looks of the baby. Every 

I mother imagines her offspring is the best looking, the 
brightest, the most wonderful baby alive. To acquaint- 
ances other views may be held to be true. Should the 
baby be a Twilight Sleep baby . . "dream babies," they 
have been called . . and if Twilight Sleep has prevented 
the indiscriminate use of forceps, it is natural that the 
child will escape markings and, sometimes, injury to the 
skull. Otherwise these dream babies are the same as any 
other baby that was ever born. 




The Twilight Sleep Baby, 57 

i. Toale baby weighs about seven and a half pounda at 
birth. A female baby is usually about half a pound less 
in weight. These are average babies. A five or six 
pound baby may be just as good a baby. There are cases 
of babies weighing, when born, eight, ten, twelve and 
fourteen pounds. Such babies are possible, but when a 
baby weighs over nine pounds the statement must be ac- 
cepted with reserve and allowance made for certain inac- 
curacies, such as faulty scales or mere guesswork. 

Most new parents become alarmed at the shape of the 
new-bom's head. It is a shapeless thing, the result of 
pressure on it during its progress through the birth ca- 
nal. A very prominent swelling appears for a few hours 
on that part of the baby's head that was subject to the 
greatest pressure. This is known as the ' ' caput sueced- 
aneum." If left alone and not handled it will disappear 
in a few days. 

Some babies are born with a thick head of hair. This 
fact seems to please the new parents. Then the hair falls 
out. This is natural. Whether a baby is born with an 
abundance of hair or with Mttle or no hair, what hair 
there is will fall out and following this the permanent 
hair will grow in. 

It is unusual these days to hear of a baby suffering 
from "sore eyes." It is natural that the secretions of 
the mother, as the infant passes through the birth canal, 
should affect the baby's eyes. Not only inflamed eyes, 
but even blindness may result. If a physician is in at- 



1 

I 



58 Twilight ISlbbp r 

tendance he will care for the little one's eyes at the time 
of birth. If, for various reasons, the baby is bom and 
no doctor is at hand, a 2 per cent, silver nitrate solution 
should be procured. The eyes are cleansed with a boric 
acid solution. Then a few drops, in each eye, of the sil- 
ver nitrate solution should follow. As a rule this pre- 
vents further trouble. Should the eyes become iuQamed 
and exude pus a doctor should be consulted at once. 
While waiting for the doctor, clean the eyes with a mild 
antiseptic solution, being careful that all objects that 
come in contact with the baby's eyes are clean, and after 
using them they should be destroyed. 

As a rule the baby loses weight the first week of life. 
"We have, seen that 477" of the Twilight Sleep babies do 
not lose but gain weight during the first week of life. 

As the nourishment the baby takes in is not equal to 
the waste thrown off, during the first ten days of life, it 
is natural that there should be a loss in weight. This 
loss is usually about one-tenth of the body weight of the 
child. On an average when the baby is ten days old it 
weighs exactly what it did at birth. 

If the navel is kept dry and is not bandied it should 
drop off from the fourth to the eighth day. 

Shortly after the baby is born it gets its first bath 
This is of oil, benzoinated lard, vaseline, or some such 
lubricant. The entire body is anointed. Then wrap it in 
flannel and place in a warm, dry place. 



J 



After a few hours the baby is bathed. The room should 
be warmed. Guard the baby against chilling. Until the 
naval cord drops off the baby does not get a full bath. 
Give sponge baths. Use warm water and some pure 
soap. Castile soap is best. After the cord has dropped 
off the baby may receive a full tub bath. The water 
should be 100° Fahr. Use a soft, boiled cloth to wash it 
with and not a sponge. Use separate water for the body 
and the face. Dry the baby with a soft towel. Do not 
rub the skin. Avoid any irritation. 

If the skin is dehcate do not use soap. Put a bag of 
cheesecloth containing a pint of bran into the water for 
five minutes before the bath, and squeeze it thoroughly. 

"Wash the eyes with a solution of boric acid . . a tea- 
spoonful to the pint. Prevent chafing by changing soiled 
diapers and cleansing the child at once. Sprinkle a dust- 
ing powder in the folds of the skin, or rub with olive oil 
or cocoa butter. 

The baby's clothes should be loose and hang from the 
shoulders. Do not overdress the infant. In summer, 
use the thinnest gauze shirts, and in winter a medium 
weight of flannel. In winter, when the infant goes out of 
doors, thick warm coats and leggings are better than 
heavy flannels. If this point is observed, the baby will 
not be so likely to suffer from "colds". 

The Fontanelles are the open spaces where the bones 
of the baby's skull do not meet. There are two; one kite- 
shaped, the other triangular. 



L 



At from fourteen to eighteen months these Bhonld be 
entirely closed. If there is any opening at the end of the 
second year, an arrested development is indicated and 
medical advice should be sought. 

A healthy baby should be able to hold np its head by the 
third or fourth month. It should sit unsupported, and 
crawl or creep from the fifth to eighth month and stand 
when a year old. At about fifteen months it will try to 
walk unassisted. Some babies of unusual strength walk 
when a year old or even sooner. 

When a year old, the baby will pronounce simple words, 
an "Mamma" or "Papa." If, at the age of two years it 
has not attempted to speak, see a doctor, as the fact will 
indicate an arrest of development, deafness, or the first 
signs of idiocy. 

There are exceptions to all these general rules. 

Children usually shed no tears before the third or 
fourth month and the saliva appears likewise about the 
third month. 

The healthy movement of an infant varies in color 
from the light orange to a greenish yellow. The reaction 
is always acid. The smell should never be offensive, but 
should resemble that of sour milk. 

Abundant perspiration is not observed in very yoimg 
children. 

A child should grow from sis to seven inches the first 
year. 



The Twilight Sleep Baby. 61 

A new-bom baby will sleep from twenty to twenty-one 
hours out of the twenty-four. 

Do not get worried if a male child does not pass urine 
for the first day or two. This often happens. Always 
notify the doctor, however, so that he may make sure the 
fact is not due to any malformation. 

Teething commences usually from the fifth to seventh 
month, and continues until the child is about two and a 
half years of age. The following table indicates in 
months the usual time of the appearance of teeth: 

FiBST Teeth. 

Lower Lateral Licisors and 1st Molars . . 15 to 21 Months. 

Lower Central Licisors 6 to 9 Months. 

Upper Incisors 8 to 10 Months. 

Canine 16 to 20 Months. 

Second Molars 20 to 24 Months. 

Second Teeth. 

First Molars 6J4 Years. 

Second Middle Licisors 7 Years. 

Second Lateral Incisors 8 Years. 

First Bicuspid 7 Years. 

Second Bicuspid 10 Years. 

Canines 11-12 Years. 

Second Molars 12-13 Years. 

Third Molars 17-21 Years. 



62 



Twilight Sleep in Amehtca. 



The lower jaw is usually a little in advance of the up- 
per. 

In nursing the baby, note the following suggestions: 
If the mother massages her breasts and nipples daily for 
several weeks before the baby comes, she will find that 
her nipples keep smooth, the tender skin will not crack, 
and she will be saved a great deal of suffering. 

After childbirth, you may wait for six or eight hours 
before putting the baby to the breast. 

Put the baby to the breast every four hours until the 
milk comes, which is usually on the third or fourth day. 

After this, nurse the baby every two hours, using both 
breasts, from 6 a.m. until 10 p.m., with one feeding at 
2 a.m. 

When nursing the left side, hold the baby on the right 
side with its head resting on the left arm of the mother, 
while the mother lies on her left side. The reverse is 
true when the baby nurses the other breast. 

When the mother sits up to nurse the baby she should 
lean forward and depress the breast with the fingers of 
her free hand so as to keep the weight from pressing 
against the baby's nose. 

Observe regularity in nursing. 

It is the habit of some mothers to shirk maternal re- 
sponsibility, and instead of nursing the baby, to feed it 
from a bottle. If the mother is strong and healthy, with 
plenty of g'ood milk, the baby cannot thrive on anything 



The Twhjght Sleep Baby. 63 

else so well. Many children are handicapped through 
life, invalids from childhood, because the mother shirked 
her duty. 

In many cases, however, it becomes necessary for a 
mother to wean her baby before the usual time. Should 
a mother be tuberculous, it is better for the child to be 
fed by a bottle. This is also true should the mother have 
an infectious or contagious sickness, or should she be 
weak or suffering from any disease that is liable to ex- 
tend over a protracted period. But in every case a phy- 
sician should be consulted. He alone is competent to give 
a milk formula for the baby. 

Any bottle, not too large, may be used to hold the ba- 
by's food. It is not the bottle, but the care of the bottle 
that is important. 

Before filling a bottle, it should be boiled for ten min- 
utes, or left to stand in water containing a half teaspoon- 
ful of baking soda. 

Once a day, the bottles should be washed, both inside 
and out, with a bottle brush and soap and hot water. 
Never refill a bottle that has not been properly cleansed. 

The nipples should be allowed to soak in a solution of 
boric acid and water when not in use. Once a day they 
should be turned inside out and thoroughly washed with 
hot soap-suds. Two or three times a week they should 
be boiled for ten minutes. Put the nipple directly on the 



64 Twilight Sleep in Amebioa. 

bottle. Do not use a contrivance in which the nipple is 
connected with the bottle by a tube. 

Twilight Sleep babies may not be perfect babies— but 
one fact has been proved, — they, at least, get a fair start 
in the race of life, from the standpoint of good healtL 



Hygiene and Pbegnancy. 



CHAPTER 7. 



Hygiene of Pseqnancy. 



65 

4 



As, -we have shown in the first chapter, pregnancy, in 
itself is a natural condition and should proceed normally. 
But, with the advance of civilization, child-bearing tends 
to become more and more abnormal. Hence, it is the 
duty of a woman who expects to bear a child, to take 
care of herself and to live so correctly during pregnancy 
as to make the process, if possible, what Nature intended 
it should be. It is a duty she owes herself and her child. 
By thought and care during the nine months she is carry- 
ing the child, she may save herself great pain and even 
operative interference at the time of labor. 

It is readily seen that if this holds true in cases of nor- 
mal deliveries how much more essential it is for the body 
to be in perfect condition when the case is to be one of 
Twilight Sleep. 

The minute a woman becomes suspicions she is preg- 
nant she should consult her doctor. It is an error to 
wait two, three or four months, make certain prepara- 
tions for tie future child, and then engage an obstetri- 
cian. In no few cases she is surprised to learn that she 





66 Twilight Sleep in Amebica. 

is not pregnant but that one or more of many patho- 
ligieal abdominal conditions are present. Very often the 
loss of two or tbree months makes what would be a sim- 
ple case assume serious aspects. 

Hhe average woman imagines she is pregnant when 
she passes a menstrual period. In a majority of cases 
it does point to pregnancy. However, from a scientific 
viewpoint, this is not a positive symptom of pregnane)'. 
Therefore when a woman previously regular in her 
monthly sickness misses a period she should seek her 
physician and have a diagnosis made. 

A diagnosis of pregnancy having been made the physi- 
cian will instruct the patient concerning many matters. 
It is only for the purpose to bring these facta out in 
bold type that the ensuing is written. 

There are certain DANGEE SIGNALS every preg- 
nant woman should know and when one or more of them 
become present send for her doctor post-haste. Not onlr 
the life of the future child but the mother's life, in this 
way, may be saved. 

These danger signals are : 

Headaches : especially frontal headaches ; extending 
from the eyes backward. 

Faulty vision. This may be constant or happen at cer- 
tain periods. 



Hygiene and Preonahcy, 

Persistent vomiting. This differs from the usual 
morning sickness. All food is rejected at all periods of 
the day. 

Bleeding. No matter how slight or long it lasts it 
points to a possible miscarriage. 

Swellings or puffiness about the hands, face or feet. 
This often indicates a kidney lesion. Do not fail to send 
the urine of the pregnant woman to the physician as he 
orders. The urinary examination is an important factor 
in pregnancy. 

Cramp-like pains, or any sudden pain in the lower ab- 
domen. This often is a fore-runner of a miscarriage. 
Appendicitis often occurs during pregnancy, 

Faintness. This may point to a heart condition. This 
is a serious compEcation in pregnancy. It is known, how- 
ever, that when a woman goes to term, if a heart condi- 
tion is present. Twilight Sleep is an aid to the mother. 

Cessation of the feeling of "life". This points to the 
death of the foetus and requires skilled care, 

A pregnant woman should discard all tight clothing as 
soon as she is aware of her condition. Ordinary corsets 
should never be worn. The clothes should hang from the 
shoulders as much as possible. She should wear some 
thin woolen material next to the skin to avoid taking 
"cold". 

If the abdomen is pendulous and hangs heavily, some 
maternity corset or binder should be worn. If the breasts 




I 



TwnjoHT Sleep is Amkeica. 

are pendulons and heavy, similar supports should be 
used. 

High heeled shoes should not be worn. Low-heeled, 
common-sense shoes are best. Bound garters should be 
discarded. They impede the eirenlation through the 
veins. 

During the early months of pregnancy exercise may U 
regulated according to the inclinations of the woman. 
During the period of "morning sickness" she should in- 
dulge in no exercise. At a later period walking is the 
best exercise the pregnant woman can take. She should 
walk at a gait that insures deep breathing. Never exer- 
cise to the point of fatigue. If, for any reason, the wo- 
man cannot take a daily walk, at least she should make 
it a habit of sitting in the sun for a certain period each 
day. During the last months of pregnancy walking may 
be continued. Light housework is good exercise. She 
should not take long automobile rides over rough roads, 
lift heavy weights, run a sewing machine for any length 
of time, run up or down stairs, or take horse-back rides. 
Lots of fresh air day and night should be a standard rule. 

The pregnant woman nourishes two beings. Therefore 
it is essential that she partake of wholesome, nourishing 
food. She should avoid all rich, indigestible articles of 



I diet. She should drink plenty of water, milk, or cocoa 
Tea or coffee should be taken in moderation and alcoholic 
drinks NOT AT ALL. It often happens that the preg- ] 
nant women craves unusual food. In most cases this I 



Htqienb and Pbegnanoy. 69 

living should be respected, for it reveals the need of 
the body for the particular elements which that food con- 
tains. 

In some cases the pregnant woman requires a special 
diet. In this case the physician wUl write out a list ol 
foods that may be taken. 

The skin of the pregnant woman mnst be kept active 
by frequent bathing. In the morning a cool (not cold) 
sponge bath and at night a warm tub bath are best. 
Later on in the pregnancy the waste products of the body 
are increased and, therefore, it is very necessary tiiat 
these baths become a routine. Many claim that if the 
abdomen be rubbed with an oil the labor will be made 
easier. This is not true. The only good the rubbing 
does is to exercise the abdominal muscles. 

The pregnant woman should sleep more than under or- 
dinary conditions. During the later months the active 
fcEtal movements interfere with the woman's rest. If it 
becomes impossible for the woman to get sufficient rest 
she should report the facts to her physician. 

During pregnancy the teeth are liable to decay. The 
teeth should receive special attention. They should be 
cleansed with a soft tooth brush and the mouth thor- 
oughly rinsed. As soon as a diagnosis of pregnancy has 
been made a dentist should be consulted. 

Constipation is to be avoided. To eliminate properly 
all waste products is most important for a normal preg- 



4 

.1 



70 Twilight Sleep in Amebioa. 

I 
nancy. Plenty of water should be taken, the coarser ce- 
reals and vegetables should be chosen, and if necessary a 
daily dose of some laxative given. 

If a woman will begin to massage her breasts and nip- 
ples daily after the sixth or seventh month, she will find, 
when she comes to nurse her baby, that her skin will be 
in a much better condition. Cocoa-butter, olive oil or 
vaseline may be used to advantage for this purpose. 
Many women have suffered from cracked and tender nip- 
ples. At times the nipples should be washed with a solu- 
tion of boric acid. Care on the prospective mother's 
• part might have saved her much unnecessary pain. 
Pregnancy affects the mental condition of women dif- 
, ferently. Some continue very much as before, but others 

suffer from mental depression, are suspicious and un- 
happy, and, in fact, almost seem to change their natures. 
Such patients should be guarded from all annoyances, 
their spells of irritation overlooked and everything done 

I to make them happy. It has been claimed that Twilight 
Sleep affects the mind of the patient postpartum. This 
is an error, as we have seen. During labor, it has been 
the experience of some physicians, the patient has suf- 
fered from a form of delirium. In these cases of Twi- 
light Sleep the drugs used have not been the ones advo- 
cated or else their administration has been faulty. From 
records of cases we have reported it has been proven that 
no mental condition caused by the drugs ensues. 



J 



Hygienb and Pbegnanoy. 71 

In ordinary cases the patient selects her nnrse or seeks 
her physician for advice. In Twilight Sleep cases the 
nurse or nurses in charge should be ones who have had 
training, especially in obstetrics. Many of the hospitals 
of America have and are training nurses to be proficient 
in Twilight Sleep work. Therefore if the pregnant wo- 
men expects to be delivered by this new method it is best 
for her to leave the selection of the nurse to her doctor. 

As the time draws near for the labor, a woman should 
have everything for herself and the baby in readiness. 
The nurse and the doctor should be a settled question and 
arrangements made if the woman expects to go to a hos- 
pital for the delivery. If the labor will be at home the 
room should be prepared. Then, the last days before la- 
bor may be spent in peace, the best preparation for the 
experience ahead. 



72 Twilight Sleep in Amebioa« 



CHAPTER 8. 

The Lying-in Boom and Nubseby. 

If the pregnant woman decides to have her baby at 
home the selection of a room for the delivery is very 
important. This is doubly true if the method is to be 
the painless one of Twilight Sleep. 

The room should be so situated that all unnecessary 
noises will be excluded. Noise is no aid to the Twilight 
Sleep state. 

It should be fairly large. The ventilation should be 
good. All heavy curtains and draperies should be re- 
moved. 

The bed should be narrow and high. An ordinary cot 
bed raised by placing blocks under the legs suffices. 

Over the mattress a rubber sheeting is placed. Over 
this is placed a sheet. Another length of rubber sheeting 
is arranged over the sheet and on top of this is placed 
another sheet. This is called the draw sheet. Some 
place still another rubber sheet over this covered with 
prepared padding. In many cases a Kelly pad does 
away with this last covering. In this way after the birlii 



The Lyinq in Boom and Ntjbbebt. 

of the baby the soiled bed clothes may be removed leav- 
ing a clean bed nndemeath. 

Two or three plain, straight-back chairs should be 
ready. 

The floor, if covered with a carpet should be covered 
with a material that will insure the carpet not being 
soiled and ruined. If the floor is covered with rugs these 
should be removed and the floor protected. 

In normal cases the baby is bom with the mother in 
t)ed. Should a complication arise and forceps ased, a 
Version, etc. have to be done, the bed is a poor place for 
such an operation to take place. Provision should be 
ttiade for this emergency. 

Some physicians have a portable operating table they 
Send to the patient's home. An ordinary kitchen table 
does as well, though, and is the most used. This table 
should be about three to five feet long and two feet wide. 
It is covered with enough thicknesses of blankets to make 
for comfort to the patient. A rubber sheeting is placed 
over this and a sheet is the final covering. 

It is well to have this table, ready for use, prepared and 
placed in one corner of the room. 

An instrument table should be provided. Any small 
table does for this purpose. The nurse or the doctor will 
dress this table as it must of necessity be sterile. 

The bed, the delivery table, the instrument table and 
the room prepared, all is ready for the patient. 




^B sair 



74 

Whether the patient has to provide any further for the 
delivery depends on the individual physician in charge. 
It is well to ask your doctor to give you in detail what 
you will have to provide. 

After the labor begins and the nurses and doctor have 
given the first dose of Scopolamine and Morphine it is 
well for the rest of the family to repair to a distant part 
of the dwelling. At best they are in the way and of no 
value. Should they be needed the doctor can always send 
for them. The relatives of the woman in the Twilight 
Sleep state are of most value when far distant from the 
sick room. 

The selection and preparation of the nursery should 
be considered some time before the baby is bom. 

If possible the room should adjoin the room of the 
mother. This makes it possible for the mother to care 
for her infant and at the same time when the infant is 
separated from her, her rest will not be disturbed. 

In many eases it is impossible to provide a separate 
room for the baby. It becomes necessary that mother 
and child occupy the same room. When this is the case a 
crib or basket should be provided for the child. Mother 
and child should not sleep in the same bed. Instances 
are by no means uncommon in which the baby has been 
suffocated during sleep because the mother occupied the 
same bed with it. 



^^m 




The Ltikg-in Room and Nurseey, 



?^e room should be of fairly good size, with plenty of 
sunshine and good ventilation. 

The open fireplace is the best means of heating the nur- 
sery. If this ia possible it is a good suggestion to have 
the coal placed in bags. When more coal is needed for 
the fire a bag is placed on the fire. In this manner little 
dust is raised, there is no noise and mother and child are 
not disturbed. 

The Franklin heater comes second to the open fireplace. 
In city and town houses hot air from a furnace is the 
usual method of heating. It is far from ideal. Steam 
heat is bad as the baby is made a victim of eolds. Heat- 
ing by a gas stove or an oil-heater is never justified. 

The temperature should be kept at from 68 to 70 de- 
grees Fahr. To take the temperature of a room the ther- 
mometer is placed in the center of the room about three 
feet from the floor. At night, during the first few months 
of life the temperature may be allowed to fall as low as 
65 degrees Fahr. Later on a night temperature of 55 
degrees is allowable. 

The nursery should be lighted by a small candle or a 
night lamp with a small flame. Gas or kerosene should 
never be used. They use up too much oxygen and by 
combustion give off noxious gases. 

The nursery should be aired twice daily. If baby and 
mother occupy the same room the mother should be well 
covered and the baby removed to another room when the 



76 TwnjoHT Sleep in Amebioa. 

room is aired. If, wliile the windows are open, a towel 
or sheet is shaken about the room, the air will the more 
quickly be changed. After the baby is three months old 
an open window should be the rule, except in freezing 
weather. To avoid drafts several thicknesses of cheese- 
cloth are placed over the open window. A ventilating 
board may be used in place of the cheese-cloth. 

Cooking, washing or drying of clothes should never be 
permitted in the nursery. Good air and good food is es- 
sential for a good baby and the mother should see that it 
■ gets both. 
As far as possible dust should not be allowed to collect 
in the nursery. Dust-protectora should be screwed in all 
corners. The floor should be painted or, if of hard wood, 

1 remain unpolished. Paint instead of paper is best for 
the walls. If paper be used it should contain no green 
coloring matter and have a hard finish. There should be 
no picture moulding in the room. Such mouldings are 
dust collectors. 
All furniture should be easily dusted, therefore should 
be as plain as possible. Mission furniture is ideal for 
the nursery. 
The old fashioned crib was bulky and not practicable. 
In any store supplying baby things a modem baby's bed 
may be bought at little cost. 
The room should be frequently cleaned. All dusting 
should be done with a damp cloth. The infant should be 
removed to another room while the cleaning goes on. 




The Lying-in Boom and Nubsbby. 77 

As the child grows older the furniture of the room, the 
wall decorations and the play-things change. It is not 
in the scope of this small volume to consider this phase 
of the baby's growth, but many and good books have been 
written that deal with this subject. 



78 Twilight Sleep in Amebica. 



CHAPTER 8. 



Home Nubsing. 



During the lying-in period, in a case of Twilight Sleep, 
the patient should always be in charge of a trained nurse. 
No matter how competent a member of the family may 
be this is, at least, one instance when they are of little 
value to the doctor. 

Before the nurse arrives and after she goes there are 
many practical things the family should know how to 
do the right way. 

The following are suggestions as to the proper methods 
of nursing: 

The preparation of the bed, the dusting and cleansing 
of a room, the heating, question of sunlight, and ventila- 
tion, we have already considered. 



MOVING A PATIENT. 



When it is desired to move a patient from one side of 
the bed to the other the person doing this operation 
passes one arm down the patient's back giving support to 
the head and shoulders. The other hand is slipped un- 
der the upper part of the back. The upper part of the 



HOMB NXJESING 79 

patient's body is then moved. The operator's hands are 
then placed under the lower part of the patient's back 
and under her knees and, in this manner, the lower part 
of the body is moved. 

Another method is to loosen one side of the draw sheet 
and getting on the other side of the bed pull sheet and 
patient to the desired place. The sheet is then replaced. 

When it is desired to lift the patient off a bed one per- 
son catches the sheet at the head and another person 
takes the sheet at the feet. This causes the patient to 
lie in a sling in which the patient may be safely carried. 

BATHS. 

For a foot bath a small tub should be ready with hot 
water or hot water and mustard. The bedclothes are 
loosened at the foot of the bed. A protection of oil-cloth 
or rubber sheeting is placed at the foot of the bed and on 
this rests the tub of hot water. The patient's feet are 
then placed in the tub and the bed clothes drawn over the 
legs. In this way no part of the body is exposed. Af- 
ter the foot bath make sure to thoroughly dry the pa- 
tient's feet. 

For a sponge bath, the water and soap and fresh 
clothes being ready, the patient is wrapped in a blanket. 
One part of the body is sponged at a time. Begin at the 
head and work toward the feet. The water should be 
changed at least twice. An alcohol sponge is given the 



^^m 80 Twilight Sleep in AusmoA. 

^H Bame way. The difference is that 60% alcohol in the 
^H water is ased and the sponged parts are allowed to dry 
^H^ themselves. 

^H For a tub bath the patient is either carried or assisted 
^H in walking to the tub. Having thoroughly soaped her all 
^H over, water, from a pitcher or paU, ia poured over her. 
^^^ This is continued until no soap is in evidence. 

^^^1 HOT AND COLD PACES. 

^H The cold packs are used to reduce temperature. 

^V The bed is covered with an oilcloth or rubber sheeting 

and over this is placed a blanket. A sheet which has been 

wrung out in cold water is placed over this blanket. The 

patient, naked, is placed in this sheet which is thoroughly 

wrapped about her. The blanket is then wrapped about 

^^ the patient. A wet towel is placed on the head. This 

^B pack is continued for from ten to fifteen minutes. After 

^H the patient has been dried she is put to bed. 

^H The hot pack is given in a similar maimer. In the hot 

^H pack, though, a blanket is wrung out in hot water. This 

^H is wrapped about the patient. Many coverings should be 

^H placed over the patient. An ice-cap is placed at the head. 

L 



POULTICES. 



A Flaxseed poultice is made by adding small quanfin 
of a solution of the meal and stirring it into boiling wa- 



le head. 

antioo^ 
uiiing wa- J 



Home Nubsing. 81 

ter. When the mixture becomes stiff it is beaten. This 
removes all lumps. The paste is spread on muslin or 
cotton. A border of at least an inch should be left for 
turning in. The top is similarly covered. A small poul- 
tice should be changed every two or three hours. A large 
one requires changing every five hours. Do not reheat an 
old poultice. 

A Mustard poultice is made by adding two parts of 
mustard and four parts of flaxseed to very hot unboiled 
water. The poultice is then prepared as already de- 
scribed. 

A mustard plaster is made by taking equal parts of 
mustard and flour, or in the proportion of one of mustard 
to two of flour, or up to four parts of flour, depending 
upon the skin of the patient . . water is then added to 
make a paste. This is spread between layers of muslin. 
When applied to a part it is left about fifteen minutes. 

ENEMAS. 

An enema is a liquid preparation for injection into the 
rectum. They are either high or low. There are many 
kinds of enema . . as, the simple, purgative, astringent, 
stimulating and nutritive. We shall, in a few words con- 
sider these different enemas as they are often ordered by 
the physician and many times no one in the family knows 
how to prepare them or give them. 

A rectal tube, after being lubricated with vaseline or 
oil, is inserted for a distance of about three to ei^kt \3a5Air 



82 Twilight Sleep in Amebioa. 

es in the rectunL TJie patient lies on her left side with 
the knees drawn up. The hips are raised. When a low 
enema is given a rectal tube or hard rubber or a foun- 
tain syringe tip is employed. 

A simple enema consists of warm water made soapy. 
It simply evacuates the bowel. It may be given low or 
high. The injection is slowly given. The tube is passed 
upward and backward. The tube is held while the con- 
tents of the enema passes into the bowel. If a half hour 
passes and the enema is not expelled it is safe to give 
another. 

Purgative enemas may be composed of the following 
ingredients : 

Six ounces of olive or castor oil followed in an hour 
with one of warm water made into soap-suds. 

A half to two ounces of glycerin with an equal amount 
of warm soap-suds. 

A half an ounce of turpentine mixed with three ounces 
of warm water. 

This is followed in half an hour with about a pint of 
warm soap-suds. 

An ounce of either Eochelle or Epsom salts and an 
ounce of turpentine with a pint of warm soap-suds. This 
is injected high in the rectum. 

Two to ten ounces of molasses combined with a pint 
of soap-suds or with twice the amount of milk and inject- 
ed high in the rectum. 



Home Nubsing. 83 

Astringent enemas are given to check diarrhoea. They 
are given slowly and as high as possible. We have the 
following combination : 

Starch is boiled and diluted with warm water nntil it 
is thin enough to run through a tube. Three ounces are 
used. It may be given alone or, when ordered by a phy- 
sician, may have added to the starch fifteen drops of lau- 
danum or thirty drops of paregoric. 

Stimulating enemas are used in cases of shock or in any 
case when it is necessary to stimulate the patient through 
the rectum. The following may be used : 

Two teaspoonf uls of salt dissolved in a quart of water. 
To make more stimulating a half to an ounce of whiskey 
may be added. 

A half pint of strained, strong black coffee, injected as 
hot as can be endured by the patient is an excellent stim- 
ulant. 

When a nutritive enema is required the patient is 
either in a hospital or a trained nurse is employed. There- 
fore we will not consider this form of enema. 

DOUCHES. 

A douche is a stream of water, alone or in combination 
with drugs, directed against a part, or used to flush a 
cavity, for purposes of cleanliness, stimulation, or to re- 
lieve inflammation or hemorrhage. A vaginal douche is 
given with the woman lying down, the hips raised and the 



84 



Twilight Sleep in Ameeioa. 



knees drawn up. A bed pan is placed under the hips to 
catch the return flow. Prom one to three quarts of water 
is used. As a rule the temperature of the douche should 
be from 105 to 120 Fahr. 

Unless plain water or water and salt is used a woman 
should consult her physician before adding drugs to the 
douche. 

USE OF BED PAN. 

Before a bed pan is placed under a patient it is warmed 
by running warm water over it. To insert a bed-pan un- 
der a patient she is asked or assisted to raise her hips. 
The patient is also raised when the bed-pan is removed. 
It should not be dragged out. 

APPLYING DEY HEAT. 



Dry heat may be employed by using bottles filled with 
hot water, rubber bags filled with hot water, sand bags, 
bricks, or irons heated. Whatever is used care must be 
taken to see that it is well covered. Otherwise the pa- 
tient is liable to severe burns. 

Ice-bags filled with cracked ice are used in applying 
cold to a part. The ice-bag should be covered in order 
to protect the underlying skin from freezing. When cold 
is applied to the head or the spine it is best to put a hot- 
water bag at the feet. 



Home Nxjesing. 



85 



It is not infrequent that a physician will leave medi- 
cines and tell the family to make solutions of varying 
strengths. A trained nurse has a chart of solutions but a 
layman is in a quandary, telephones his doctor and, in no 
small number of cases, gets the instructions wrong. For 
this reason the following tables are given. 



TABLE FOB MAKING ONE PINT OF ANY DBUG. 

Strength of Solutions. 

1-20,000 use y2 grain or min. (drop) approximately 



1-10,000 




1 




( ii 


ii 


1-5,000 




IV2 




i H 


ii 


1-4,000 




2 




i ii 


ii 


1-3,000 




2V2 




i ii 


ii 


1-2,500 




3 




i ii 


ii 


1-2,000 




W2 




i ii 


ii 


1-1,0001/10%" 


ly^ 




i ii 


ii 


1-500 1/5% 




15 




i ii 


ii 


1-400 1/4% 




18 




i ii 


a 


1-300 1/3% 




24 




i ii 


ii 


1-200 1/2% 




36 




i ii 


a 


1-100 1% 




72 




i ii 


11 


1-50 2% 




144 




i ii 


11 


1-40 21/2% 




180 




i ii 


a 


1-30 3y2% 




240 




i ii 


ii 


1-25 4% 




288 




i ii 


ii 


1-20 4y2% 




365 




i ii 


ii 


1-10 5% 




720 




i ii 


It 


1-5 10% 




1440 




i ii 


ii 


1-2 50% 




3600 




i ii 


li 


Bichloride of Mercury — A 


. 7% grain tablet to 1 pint of 


•water makes 


a 1 to 1000 sob 


ition. 


In a quart of water it 



86 Twilight Sleep in America. 

makes a 1 to 2,000 solution. To five pints of water it 
makes a 1 to 5,000 solution. 

Carbolic Acid (95% solution) — 2y2 ounces to 1 gallon 
of water makes a 1 to 50 or a 2% solution. Six ounces of 
carbolic acid to 1 gallon of water makes a 1 to 20 or a 
5fo solution. 

Lysol — 2y2 teaspoonfuls to 1 quart of water makes a 
Ifo solution. 

Formalin — 5 ounces to 7y2 pints of water makes a 409& 
solution. 

Boric Acid (powdered) — 6 ounces to 1 gallon of water 
makes a 4% solution. 

Chloride of Sodium (table salt)—! ounce to 1 pint of 
water makes a normal salt solution. 

Creolin — 21/3 teaspoonfuls to 1 quart of water makes a 
Ifc solution. 

For fluids the average teasiwonful holds 60 drops. 
Eight average teaspoonfuls make one ounce. 

TABLE FOB KAEINO FOUE FLUID OUNCES OP ANT DaUG. 



For a 1/10 


of 


al% solution 


use 1 4/5 grains or min. 


" 1/8 


of 


11% " 


" 2Vi " 






" 1/6 


of 


1156 " 


" 3 






" 1/4 


of 


llfo " 


" 4% " 






" 1/3 


of 


il% 


"6 " ' 






" 1/2 


of 


ilf. " 


"9 " ' 






" 1% 






" 18 " ' 






" 2%^ 






" 46 " • 






" 3% 






.. 54 ., . 






" 4% 






" 60 " ' 






" S% 






" 90 " ' 






" 10% 






" 180 " ' 







HOMB NXTBSIKG. 87 

To estimate the temperature of fluids do not trust to 
the finger or hand but use a bath thermometer. 

If you desire to use a clinical thermometer a physician 
will instruct you in its usage. The same holds true of 
counting a pulse. 

If a record of the sickness is required the attending 
doctor will signify what data he wishes recorded. 

QENERAIi CABE OF THE SICK. 

The surroundings are important. They should be quiet 
and contain nothing that irritates the patient. The pa- 
tient should be made as comfortable as is possible. 

Never talk over the case before the patient. Very 
often a remark, unimportant in itself, heard by the pa- 
tient causes great mental anguish. 

AU sick records should be kept in a safe place not avail- 
able to the patient. 

Visitors are necessary evils. If permitted they should 
remain only a few minutes at most. Very sick patients 
should not be permitted to have visitors. 

Eemember the sick require only those about them who 
exercise tact and gentleness. 

A keen understanding, kindness, the appearance of no 
fuss, and the air of optimism does much to cheer a patient 
and start her on the road to normal health. 



88 Twilight Sleep in Amebioa. 



CHAPTER 10. 

Questions and Answebs. 

Q. What is TwiUght Sleep! 

A. A partial narcosis of a woman in labor. 

Q. What drugs are usedf 

A. Scopolamine and Morphine. 

Q. What effect do these drugs have on the patient! 

A. The labor pains are not so severe and an appercep- 
tion of pain is produced. 

Q. Does the patient feel the labor pains at the time of 
the pains? 

A. She does. 

Q. Does she give external evidences of these pains f 

A. She does. 

Q. Howf 

A. She cries out, tosses herself about the bed and begs 
the doctor to do something to aid her. 

Q. Then according to external appearances she pre- 
sents the same picture as a woman going through an or- 
dinary labor! 

A. She does. 



Questions and Answers. 89 

Q. K she appreciates these pains why the term, ** pain- 
less childbirth?" 

A, Although she appreciates the pains at the time, 
half an hour later she has no memory of her suffering. 

Q. Therefore the lack of memory of pain is the most 
important factor in Twilight Sleep? 

A. It is. 

Q. Is it possible for a woman to be in the Twilight 
Sleep state and, due to a faulty technique, suddenly ap- 
preciate and remember her pain? 

A. It is. 

Q. If she comes out from the Twilight Sleep state and 
suffers pain before receiving new injections of the drug, 
wiU she remember after the labor is over that period of 
pain? 

A. She will. 

Q. Does this condition happen to many women while 
heing Twilighted? 

A. It has frequently happened. 

Q. Is it possible for a woman to come out from the Twi- 
light Sleep state one to several times? 

A. It is. 

Q. Is there a name for this condition, if so what? 

A. It is called an * * Isle of memory. ' ' The more * * Isles 
of memory'' the less successful the case. 



^^r 90 Twilight Sleep in America. 

^^L Q. After a case is over how long a time elapses before 

^^m the woman is her normal mental self again? 

^^H A. It depends on the dosage. As a rule in about two 

^^B to three hours. 

^^M Q. Do the drugs depress the heart! 

^^M A. Theoretically they should. Clinically no apprecia- 

^^H hie change has been demonstrated. 

^^B Q. Is it true that a woman in the Twilight Sleep state 

^^P Buffers great thirst? 

^B A. She has a dryness of the mouth and throat. Water 

^H is given freely throughout a case of Twilight Sleep. 

^H Q. If a pregnant woman has heart trouble should she 

^B heTwiUghtedT 

^^^ A. She should. 

^m Q. Whyf 

^^ A. Because by lessening the shock of the labor and les- 
sening the pain the heart is not depressed. 

I' Q. Does Twihght Sleep make what would be a compli- 
cated case a normal one? 



A. It does not. 

Q. It has no influence on the position of the child in 
the mother! 

A. Absolutely none. 

Q. After the birth of the baby is the mother in better 
physical condition than she would be had she not had 
Twilight Sleep t 



Questions and Answebs. 91 

A. She is. 

Q. In what way is she in better physical condition I 

A. She has suffered a minimnm of shock. She is 
not exhausted from her efforts to give birth to !her 
child. Her nervous system is in a normal condition. 

Q. A woman who has had children the **old way" 
and has had one by the **new way" is able to appreciate 
the difference between both methods? 

A. She is. 

Q. Has this been demonstrated ? 

A. It has. 

Q. Provided a woman is physically suited for Twilight 
Sleep will the method be successful? 

A. Not necessarily. 

Q. Why? 

A. The drugs do not have the proper effect on some 
women. 

Q. Is a labor case longer in duration when Twilight 
Sleep is the method employed? 

A. As a rule it is shorter. 

Q. How many stages is a labor case divided into ? 

A. Three stages. 

Q. Explain. 

A. The first sign of labor is known as the first stage. 
The **real labor" up to the birth of the child is known 
as the second stage. The third stage is the delivery of 
the after-birth. 



I 



92 Twilight Sleep in Amebioa. 

Q. What stage is shortened by Twilight Sleep? 

A. The second stage. 

Q. In all cases. 

A. Not in all eases, naturally. In women who have had 
children this rule holds fairly true. In a case of a wo- 
man having her first baby, some claim that when ike 
baby's head is at the "outlet" labor is prolonged. 

Q. Is there any advantage in prolonging the birth of 
the head of the baby when it is at the outlet! 

A. There is. The parts have a chance to become ac- 
customed to the new roles they have to play, dilitation is 
slower and lacerations are not so frequent. 

Q. Has this been demonstrated by actual figures I 

A. It has. 

Q. What is iwst-partum hemorrhage? 

A. Bleeding that occurs from the womb after the after- 
birth has been removed? 

Q, Is it true that a woman who has had Twilight Sleep 
is more prone to post-partum hemorrhage? 

A. No. It has been shown that the drugs used ia Twi- 
light Sleep have no effect on the womb except, if any- 
thing, to make it contract to normal more quickly, and 
therefore prevent bleeding, 

Q. How long does the new mother remain in bed after 
the birth of the baby provided she has been Twilighted? 



QuEsnoKs AND Answkrs. 93 

A. Some get up the first or second day. American 
doctors, as a rule, keep the new mother in bed from five 
to ten days. In this respect they differ from their Ger- 
man colleagaes. 

Q. Is it true that after a case of Twilight Sleep is over, 
if snccessfnl, the patient has absolutely no memory of the 
birth of her baby? 

A. It is. 

Q. Is it dangerous to the baby? 

A. If properly administered the baby suffers no ill 
effects. 

Q. Has this been demonstrated clinically? 

A. It has. 

Q. At the time of birth are Twilight Sleep babies any 
better than other babies ? 

A. No. 

Q. Are Twilight Sleep babies better looking? 

A. As a rule a Twilight Sleep baby is well nourished 
and a well nourished baby is a good looking baby. 

Q. When a Twilight Sleep baby is three or five years 
old is it a better baby mentally than other babies? 

A. Not necessarily so. 

Q. Have many doctors' wives had Twilight Sleep? 

A. From reports no small number have had this meth- 
od of painless childbirth. 



94 Twhjght Sleep in America. 

Q. Should Twilight Sleep cases all be done in the hos- 
pital? 

A. A hospital is the ideal place for a Twilight Sleep 
case. 

Q. May a Twilight Sleep case be conducted at the pa- 
tient's home? 

A. Provided the patient's home presents the proper 
surroundings and the patient can afford trained nurses it 
may be conducted at home. 

Q. Have many women in America been Twilighted at 
home? 

A. No small number. 

Q. What is the opinion of the medical profession re- 
garding Twilight Sleep? 

A. The majority of the specialists doing obstetrical 
work have faith in and practice this method. 

Q. Is Twilight Sleep a passing fad? 

A. No. 

Q. Will it become more universal as time passes ? 

A. It wiU. 



Rbstjmb op TwnjGHT Sleep. 95 



CHAPTER 8. 
Resume of Twilight Sleep. 

It has been found that the more intelligent the woman 
the more successful, in most cases, is the application of 
Twilight Sleep. 

From the reports of 1,000 cases submitted by men of 
reputation the figures show that ** Twilight Sleep'' is not 
dangerous to the mother. 

The Twilight Sleep mother after the birth of her child 
is in excellent physical condition. She does not suffer 
from nerve exhaustion. 

Twilight Sleep does not do away with the use of for- 
ceps. Forceps are valuable in many cases. What Twi- 
light Sleep does do is to prevent the indiscriminate use of 

forceps. 

In many cases of Twilight Sleep the mother has richer 
milk. This makes for better nourished babies. For this 
reason Twilight Sleep babies are called better babies. 

The figures in 1,000 Twilight Sleep cases show that 
there was not a single instance of insanity. 

Eighty five per cent, of Twilight Sleep cases are suc- 
cessful. 

The Twilight Sleep drugs have no effect or not the 
proper effect on some women. 

As a rule the lying-in period is shortened in Twilight 
Sleep cases. 



The reported figures show that fewer lacerations occur 
in Twilight Sleep cases. There are times when lacera- 
tion is inevitable. ■ 

Twilight Sleep has no influence on the position of the 
child in utero. | 

It is beneficial in "heart" eases. 

The percentage of babies bom dead is reduced 10% in 
Twilight Sleep cases. 

It is safe when conducted by a competent obstetrician. 

General surgery was done with the patient under the 
effects of scopolamine and morphine before the drugs 
were used in obstetrics. 

Twilight Sleep will have a tendency to prevent race 
suicide among the well to do and other classes of women 
who should and could have children but who fear the or- 
deal of childbirth. 

Lectures are being held throughout the United States 
by doctors, nurses, and mothers who have experienced 
Twilight Sleep, or painless childbirth. All women who 
keep abreast of the times should attend these meetings. 

The hysteria wave having passed, the proper status of 
TwiHght Sleep has been determined. It is not for every 
woman. All do not require it. But for a certain type it ' 

is a blessing. 

Twilight Sleep is beyond the esperimental stage. 

Thousands of doctors in America are experts with lie 
Twilight Sleep drugs. 

Any safe method of reducing the pain of birth is justi- 
fiable. 

The parturiant woman demands more than the conso- 
lation of Biblical references. 

Twilight Sleep is in America to stay. 




0332 smith, A. 40667 
864 Tvilight sleep in 



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